Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents.

OBJECTIVES: Hepatitis C virus (HCV) infection affects >3% of the US population, which over time can lead to cirrhosis and hepatocellular carcinoma. The lack of a reliable screening method for HCV before 1992 resulted in a higher prevalence of the virus in adults with congenital heart disease who underwent corrective surgery that required blood transfusions. Direct-acting antiviral agents such as sofosbuvir/ledipasvir have significantly increased the efficacy of HCV therapy, although use of these medications in adults with congenital heart disease has not been described. METHODS: Ours was a retrospective study of 188 adults with congenital heart conditions who had cardiac surgery before 1992. These patients were screened for HCV using HCV antibody followed by HCV RNA if the screening test was positive. RESULTS: Of the 188 adults, 116 (43% male patients, 24-70 years) were screened for the HCV antibody, demonstrating that 104 individuals were negative and 12 subjects were positive for the virus. Subsequently, further testing for the presence of HCV demonstrated 11 of 12 were infected, with an overall prevalence of 9.5%. Five individuals chose to be treated with sofosbuvir/ledipasvir and 5 of 5 have successfully cleared the virus and are considered cured. CONCLUSIONS: Adults with congenital heart disease who underwent cardiac surgery before 1992 warrant being screened for HCV, and, if testing positive, may be considered for therapy using direct-acting antiviral agents with close monitoring for cardiac complications.

Assessing L2 lexical versus inflectional accuracy across skill levels.

This study measures whether number and type of morphemes in an elicited imitation string results in a greater number of modifications with L2 experience. Rationale is drawn from L2 working memory processing limitations at distinct levels of proficiency. 38 subjects (L2 Spanish university students) comprise three proficiency groups: beginning, undergraduate majors and graduate students. Number of morphemes was varied within each syllable count; and responses were either correct or modified (lexemically/inflectionally as deletions or substitutions). Two way ANOVAs determined significance between mean proportions for each group. Findings indicate that increases in number of morphemes yielded significant differences; and that while the lowest proficiency group produced higher proportions of lexical deletions, the more advanced groups' modifications were inflectional substitutions.

The Educating Pharmacy Students and Pharmacists to Improve Quality program: tool for pharmacy practice.

OBJECTIVE: To describe (1) the importance of understanding quality measurement and improvement and (2) the development and potential uses of the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) program. PRACTICE DESCRIPTION: The EPIQ program is applicable to all pharmacy practice settings. PRACTICE INNOVATION: EPIQ was developed as a quality improvement education resource, for use by pharmacy faculty and other professionals, to teach student pharmacists, pharmacists, and other stakeholders about measuring, reporting, and improving quality in pharmacy practice. RESULTS: The EPIQ program contains 17 sessions that have been packaged in five modules addressing (1) the status of quality improvement and reporting in the U.S. health care system, (2) quality improvement concepts, (3) quality measurement, (4) quality-based interventions and incentives, and (5) application of quality improvement to the pharmacy practice setting. Each standalone module can be used in a variety of orders and are not sequential in nature. Individual pharmacists may choose one or more modules to meet individual continuing education (CE) requirements, and employers (pharmacists) may mix and match modules to develop employee training programs. Pharmacy associations and other CE providers have also used the modules to develop live CE and certificate programs. A sample of the EPIQ program and how it can be used by pharmacists is provided in this article. CONCLUSION: Gauging the current state of pharmacy quality or the extent to which intended improvements have an impact is not possible unless quality is measured. Tools for quality measurement from the EPIQ program can be used to improve pharmacist understanding of quality measurement and reporting, to interpret quality reports, and ultimately to make changes that can improve quality in pharmacy practice. Pharmacists are encouraged to use the tool described in the current work to interpret quality reports.

Examining medication adherence in older women with coronary heart disease.

UNLABELLED: The purposes of this study were to examine medication adherence in older women with coronary heart disease and to identify barriers and facilitators of medication adherence. METHODS: The study used a semistructured interview guide and established measures to examine medication taking 3 months after hospital discharge. RESULTS: Thirty-two women completed the study: 65.6% were adherent to medications, but others were less adherent and self-modified their therapy. Over half (52.1%) suffered side effects, 71.9% had experienced psychological barriers, and all had economic barriers. Facilitators included a pillbox system (85%) and discharge medication counseling (90%). CONCLUSION: Tailored interventions to improve adherence in older women are needed.

Prospective validation of eight different adherence measures for use with administrative claims data among patients with schizophrenia.

OBJECTIVE: The aim of this study was to compare the predictive validity of eight different adherence measures by studying the variability explained between each measure and hospitalization episodes among Medicaid-eligible persons diagnosed with schizophrenia on antipsychotic monotherapy. METHODS: This study was a retrospective analysis of the Arkansas Medicaid administrative claims data. Continuously eligible adult schizophrenia (ICD-9-CM = 295.**) patients on antipsychotic monotherapy were identified in the recruitment period from July 2000 through April 2004. Adherence rates to antipsychotic therapy in year 1 were calculated using eight different measures identified from the literature. Univariate and multivariable logistic regression models were used to prospectively predict all-cause and mental health-related hospitalizations in the follow-up year. RESULTS: Adherence rates were computed for 3395 schizophrenic patients with a mean age of 42.9 years, of which 52.5% (n = 1782) were females, and 52.8% (n = 1793) were white. The proportion of days covered (PDC) and continuous measure of medication gaps measures of adherence had equal C-statistics of 0.571 in predicting both all-cause and mental health-related hospitalizations. The medication possession ratio (MPR) continuous multiple interval measure of oversupply were the second best measures with equal C-statistics of 0.568 and 0.567 for any-cause and mental health-related hospitalizations. The multivariate adjusted models had higher C-statistics but provided the same rank order results. CONCLUSIONS: MPR and PDC were among the best predictors of any-cause and mental health-related hospitalization, and are recommended as the preferred adherence measures when a single measure is sought for use with administrative claims data for patients not on polypharmacy.

An empirical basis for standardizing adherence measures derived from administrative claims data among diabetic patients.

OBJECTIVE: To compare the predictive validity of 8 different adherence measures by studying the variability explained between each measure and 2 outcome measures: hospitalization episodes and total nonpharmacy cost among Medicaid eligible persons diagnosed with diabetes. RESEARCH DESIGN: This study was a retrospective analysis of the Arkansas Medicaid administrative claims data from January 2000 to December 2006. SUBJECTS: Diabetic (ICD-9-CM = 250.0 x - 250.9 x, where x = 0 or 2) patients were identified in the recruitment period July 2000 through April 2004. Patients had to be >or=18 years old and have at least 2 prescription fills in the index period for an oral antidiabetic drug. MEASURES: : Adherence rates to oral antidiabetic therapy were contrasted using the following 8 measures; including the medication possession ratio (MPR), proportion of days covered (PDC), refill compliance rate (RCR), compliance ratio (CR), medication possession ratio, modified (MPRm), continuous measure of medication gaps (CMG), and continuous multiple interval measure of oversupply (CMOS and continuous, single interval measure of medication acquisition (CSA). Multivariate and univariate linear and logistic regression models were used to prospectively predict nonpharmacy costs and hospitalizations in the follow-up year. RESULTS: A total of 4943 diabetic patients were studied. In predicting any cause hospitalization, univariate models with PDC and CMG had the highest predictive validity (C-statistic: 0.544). Multivariate models with MPR, PDC, CMG or continuous multiple interval measure of oversupply (CMOS) as adherence measures had the highest C-statistics of 0.701 in predicting diabetes specific hospitalizations. None of the adherence measures were significantly associated with nonpharmacy cost. CONCLUSIONS: MPR and PDC had the highest predictive validity for hospitalization episodes. These 2 measures should be considered first when selecting among adherence measures when using administrative prescription claims data.

An international inter-laboratory ring trial to evaluate a real-time PCR assay for the detection of bovine herpesvirus 1 in extended bovine semen.

Six laboratories participated in a ring trial to evaluate the reliability of a real-time PCR assay for the detection of bovine herpesvirus 1 (BoHV-1) from extended bovine semen. Sets of coded samples were prepared and distributed to each of the laboratories. The sample panel contained semen from naturally and artificially infected bulls, serial dilutions of positive semen with negative semen, semen from uninfected seronegative bulls, negative semen spiked with virus, as well as serial dilutions of reference virus. The samples were tested using a previously validated real-time PCR assay for the detection of BoHV-1 in each participating laboratory. The PCR tests were conducted with four different real-time PCR amplification platforms, including RotorGene 3000, Stratagene MX 3000/4000, ABI 7900, and Roche LightCycler 2.0. Virus isolation using one set of samples was performed in one laboratory. The results of the laboratories were compared with one another, and with those of virus isolation. It was found that the sensitivity and specificity of the real-time PCR test was greater than those of virus isolation (82.7% versus 53.6% and 93.6% versus 84.6%, respectively). A high level of agreement on PCR testing results between the laboratories was achieved (kappa value 0.59-0.95). The results of this study indicate that the real-time PCR assay is suitable for the detection of BoHV-1 in extended semen, and would be a good substitute for the slow and laborious virus isolation, for the screening testing at artificial insemination centres and for international trade.

Validation of a real-time PCR assay for the detection of bovine herpesvirus 1 in bovine semen.

A real-time polymerase chain reaction (PCR) assay was developed for detection of the presence of bovine herpesvirus type 1 (BoHV-1) in extended bovine semen. The assay detects a region encoding a highly conserved glycoprotein B gene. The real-time PCR assay was validated for specificity, sensitivity and repeatability using spiked semen and semen from naturally infected animals. The real-time PCR was very rapid, highly repeatable and more sensitive (lower detection limits) than conventional virus isolation method for the detection of BoHV-1 in extended semen. The specificity of the assay is as expected. The assay had an analytical sensitivity of 0.38 TCID(50) virus spiked into negative semen. The second real-time PCR system for the detection of the bovine growth hormone (bGH) gene was applied as an internal control for the DNA extraction and PCR. The bGH PCR can be performed separately to BoHV-1 PCR, or in a duplex format. The real-time PCR assay is intended for use in international trade. The complete validation dossier based on this study and an international inter-laboratory ring trial has been accredited by the Office International des Epizooties (OIE) and has been recommended to be adopted as a prescribed test for international trade.

Inappropriate use of inhaled short acting beta-agonists and its association with patient health status.

BACKGROUND: Despite the widespread distribution of guidelines on the proper use of inhaled asthma medication, the overuse of short acting bronchodilators (SABs) persists. This study aims to examine how inhaled asthma medications are used in the US and to examine whether inappropriate use of inhaled SABs is associated with poor patient health. RESEARCH DESIGN AND METHODS: The study design was a retrospective analysis of the Medical Expenditure Panel Survey (MEPS) for asthmatic patients 5 years or older who had used SAB medication during the period from 1996 through 2000. Use of SAB medication was defined as inappropriate when a patient inhaled more than 225 defined daily doses (DDDs) of SABs but less than 45.625 DDDs of corticosteroids per year. Health status was evaluated using survey respondents' perceptions on a 5-point Likert scale. Five functional limitations (activities of daily living, instrumental activities of daily living, walking, social function, and cognitive function) were rated on a dichotomous scale. RESULTS: A total of 2386 asthmatic patients were identified as having used a SAB in the period 1996 through 2000. Of these, 272 (11.4%) used excessive doses of SABs, and of this group of excessive users, 151 (55.5%) underused corticosteroids. Compared to appropriate users of SAB medication, inappropriate users had lower perceptions of their overall health (adjusted mean: 3.21 vs. 2.94, p<0.05) and mental health (adjusted mean: 2.39 vs. 2.13, p<0.05). They were also at an increased risk of limitations in walking (relative risk [RR]: 1.76, 95% confidence interval [CI]:1.15-2.71) and in cognitive function (RR: 2.32, 95% CI: 1.37-3.93). CONCLUSION: Despite the national guidelines concerning the proper use of inhaled asthma medication, over-reliance on SAB medication and under-use of corticosteroids persists in the US. Those not using asthma medication according to the guidelines had poor perceptions of their health and were subject to an increased risk of limitations in walking and cognitive function.

Prevalence and treatment of metabolic syndrome in adolescents with type 2 diabetes.

BACKGROUND: The incidence of obesity and type 2 diabetes among adolescents has risen dramatically in recent years, and it is likely that many of these adolescents also have metabolic syndrome. OBJECTIVE: To investigate the prevalence of metabolic syndrome in the patient population enrolled in a children's hospital type 2 diabetes clinic and to describe baseline pharmacologic treatment and adherence patterns. METHODS: In this retrospective cohort study, the medical charts of 52 adolescents were reviewed. A data collection instrument was used to collect demographic data, laboratory values, medication lists, and documented adherence patterns from the patient's initial clinic visit. Data collected were used to identify patients with metabolic syndrome. Data were entered into a database and analyzed using SPSS 13.0. RESULTS: Data were collected for 52 patients; of these, 40 (76.9%) had characteristics of metabolic syndrome meeting 3 or more of the 5 criteria, although only 8 (15.4%) were diagnosed with the metabolic syndrome. Among patients with characteristics of metabolic syndrome, 92.5% were taking a glucose-lowering drug, with 85% of those receiving metformin. Sixteen (40%) patients were receiving a blood pressure-lowering medication at baseline, and 4 (10%) were taking a lipid-lowering agent. Forty-three percent of these patients reported nonadherence to their prescribed drugs. CONCLUSIONS: Given these treatment patterns, pharmacologic management of metabolic syndrome in adolescents with type 2 diabetes may be suboptimal and may impact cardiovascular outcomes. It is important for clinicians to be aware of the incidence of type 2 diabetes and metabolic syndrome in adolescents so that treatment with lifestyle modifications and pharmacologic therapy may be implemented earlier.

Assessment of medication management by community-living elderly persons with two standardized assessment tools: a cross-sectional study.

BACKGROUND: The ability of patients to adhere to a medication regimen is imperative for achieving optimal outcomes. Elderly patients, especially those with memory loss, should be evaluated for their ability to manage medications to prevent significant drug-related problems. Assessment tools to determine the ability to manage medication therapy have not been tested in elderly patients with cognitive impairment. OBJECTIVES: This study compared the Medication Management Ability Assessment (M1V1AA) and the Drug Regimen Unassisted Grading Scale (DRUGS) as standardized tools to assess medication management skills in elderly patients with a range of cognitive function and evaluated the association between the results obtained from these scales and self-reported drug-related problems. METHODS: This was a cross-sectional study of older individuals living in the community. At a scheduled study visit, the research assistant (RA) questioned participants with a structured interview to document demographic information, medical history, prescription use, over-the-counter drug and dietary supplement use, health care resource use, medication management practices, and adverse drug events. Cognitive status was assessed with the Mini-Mental State Examination (MMSE) and functional status with the instrumental activities of daily living rating scale. The MMAA, which uses a fictitious medication regimen with labeled prescription bottles, and the DRUGS, which uses the patient's own prescription bottles, were administered. Three months after the visit, the RA telephoned participants to determine recent changes in living situation and drug-related problems. RESULTS: The study group comprised 52 people with a mean (SD) MMSE score of 28.3 (2.5). The participants had a mean (SD) age of 75.8 (6.2) years; 69% (36/52) were women, and 96% (50/52) were white. Participants reported an average of 4.1 medical conditions, and 88% (46/52) reported good to excellent health. Skipping doses or cutting them in half was reported by 25% (13/52) of participants who adjusted doses themselves. Almost half (44%) reported medication problems and/or medication ineffectiveness during the past 3 months at both the study visit and the 3-month follow-up (23/52 for both). The 49 participants who took the MMAA had a mean (SD) score of 19.4 (6.1), with a range of 0 to 25. Of the 49 participants with scores, 34 took less than the correct number of tablets and 13 took more. The 46 participants who took the DRUGS had a mean (SD) score of 91.6 (24.7), with a range of 0 to 100. Forty of 46 participants attempting the test attained the maximum score. Higher scores for both tests indicate better accuracy. Analysis revealed that the MMAA and the DRUGS correlated with one another (P = 0.000). We found no significant associations between these medication management assessment tools and selfreported adherence or drug-related events. CONCLUSIONS: The MMAA and DRUGS tools correlated positively with cognitive function in this population of community-living elderly persons but need further evaluation of their ability to predict who is at greatest risk for drug related problems due to nonadherence to medication regimens.

A 30-month evaluation of the effects on the cost and utilization of proton pump inhibitors from adding omeprazole OTC to drug benefit coverage in a state employee health plan.

OBJECTIVE: On March 1, 2004, the state employee health plan began covering omeprazole OTC (over the counter) at a $5 copayment. Reimbursement to pharmacy providers for omeprazole OTC increased by $10.50 per claim, from $2.50 to a $13 dispensing fee. Initially, neither generic omeprazole prescription (Rx) nor brand omeprazole Rx was covered because omeprazole OTC was available in the same strength as the Rx products at a lower cost, but an omeprazole OTC shortage necessitated coverage of generic omeprazole Rx at a $10 copay. The objective of this study was to evaluate the long-term financial impact of a drug benefit policy change on a mid-size state employee health plan and its beneficiaries associated with the addition to coverage of omeprazole OTC. METHODS: The pharmacy claims database for the employee benefits division (EBD) was used to examine utilization and cost data for beneficiaries who received proton pump inhibitors (PPIs). Pharmacy claims for the 30-month period for dates of service from December 1, 2002, through May 31, 2005, were extracted from the database, yielding a preperiod of 15 months and a postpolicy change period of 15 months. RESULTS: In the 15-month postperiod, the number of PPI claims per member per month (PMPM) decreased by 3.9%, but the days of PPI therapy PMPM increased from 1.71 to 1.82 (6.4%). Price as measured by the allowed charge per day of drug therapy decreased from $4.25 to $2.74 (35.6%) despite an increase of $1.89 (76%) in the average dispensing paid per PPI claim to pharmacies, from $2.49 to $4.38. The average beneficiary copayment decreased by $0.50 (2.0%) per PPI claim, from $25.06 in the preperiod to $24.56 per claim in the postperiod. Therefore, the net heath plan cost for PPIs decreased by $2.20 PMPM (37.6%) during the 15-month postperiod, from $5.84 to $3.64 PMPM, producing savings of $4,207,350, or annualized savings of $3,365,880, in this employee benefit plan of 127,495 members. CONCLUSION: A change in policy to include coverage of omeprazole OTC and an increase in pharmacy reimbursement for omeprazole OTC resulted in 38% net savings to a state employee health plan. The large difference in drug acquisition cost between omeprazole OTC and the other Rx-only PPIs made it possible to implement a program intervention that provided financial benefit to pharmacists, beneficiaries, and the drug plan sponsor despite a 6% increase in PPI utilization.

Freezing complete polymerase chain reaction master mix reagents for routine molecular diagnostics.

The potential of storing complete frozen real-time polymerase chain reactions (PCRs) and real-time reverse transcription PCRs (RT-PCRs), which require only thawing and the addition of template nucleic acid before PCR cycling, was examined. Master mixes containing all necessary reagents at working concentration (except template nucleic acid) were aliquoted into single-reaction volumes and stored at -70 degrees C for periods of up to 8 months. Reactions were removed from storage and nucleic acid template was added and amplified using different real-time PCR instruments. Threshold cycle values were used to monitor changes in assay performance after storage. Results for hybridization probe and TaqMan probe assays showed that freezing complete real-time PCR and RT-PCR reaction mixes was possible without deterioration in assay performance. This approach has advantages for routine molecular diagnostics in areas such as convenience, test consistency, quality control, and ease of use by nonspecialist staff.

Effects of a medication assistance program on health outcomes in patients with type 2 diabetes mellitus.

PURPOSE: The effects of a clinic-based medication assistance program (MAP) on the health outcomes and medication use of patients with type 2 diabetes mellitus were studied. METHODS: In this retrospective analysis, data from the University of Arkansas for Medical Sciences pharmacy-managed MAP and outpatient pharmacy databases were collected for adult patients with type 2 diabetes mellitus who were monitored in the university's internal medicine clinic one year before and after enrollment in the MAP. Data on patient demographics, medication use, and disease indicators (glycosylated hemoglobin [HbA(1c)], high-density-lipoprotein [HDL] cholesterol, low-density-lipoprotein [LDL] cholesterol, total cholesterol, triglyceride, and blood pressure levels) were collected for the year before enrollment and for one year after enrollment. Statistical analyses were conducted using descriptive analyses, paired t tests, and the Wilcoxon signed rank test. RESULTS: Of the 401 patients enrolled in the internal medicine clinic who were enrolled in the MAP, sufficient data were available for 52 patients, of whom 73% were women, 50% were African American, and 48% were white. Their mean age was 59 years. All were self-paying customers, with 67.3% receiving Medicare benefits. Patients received more prescription medications (p < 0.001) and antihyperglycemic medications (p = 0.001) after enrollment in the program. Mean HbA(1c) and LDL cholesterol levels decreased significantly after enrollment (p < 0.001 for both). Mean HDL cholesterol levels and systolic and diastolic blood pressure measurements did not change significantly. CONCLUSION: A clinic-based MAP managing the use of pharmaceutical manufacturers' drug assistance programs increased indigent patients' access to antihyperglycemic medications and improved patients' clinical outcomes.

Role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness.

The role of pharmacy experience and argument types in forming beliefs about pharmacist trustworthiness was studied. Study participants were recruited from three primary care clinics. They were provided a pharmacy scenario that contained information that could be used to form causal and authoritative arguments. The participants rated the trustworthiness of the pharmacist in the scenario on a 10-point, Likert-type scale and provided the arguments used to form the trustworthiness belief. Information that contradicted the pharmacist's trustworthiness was then presented in the form of an addendum, and the participants reassessed the pharmacist's trustworthiness. Participants rated the pharmacist using a Likert-type scale. Responses were coded and analyzed. Initial trustworthiness and post-trustworthiness scores were calculated. Participants' pharmacy experience score was also determined. Reliability and principal components analyses were conducted to determine the quality of the trustworthiness and pharmacy experience scores. A total of 130 patients participated in the study. There was a positive correlation between pharmacy experience and the number of causal arguments that subjects used to form their beliefs about pharmacist trustworthiness (r = 0.223, p = 0.012). Results of t tests revealed that belief strength was similar among subjects using more causal than authoritative arguments to form beliefs and in those using fewer causal arguments (t = 1.35, p = 0.179), but belief tenacity differed significantly between the groups (t = -2.303, p = 0.023). The role of external sources in influencing the formation of beliefs about trustworthiness of a pharmacist may be limited as a patient gains pharmacy experience, as experience is based on causal associations. Moreover, causal arguments are correlated with belief tenacity.

Effects on the cost and utilization of proton pump inhibitors from adding over-the counter omeprazole to drug benefit coverage in a state employee health plan.

OBJECTIVE: To evaluate the financial effects in a state employee health plan of a change in the drug coverage policy to include over-the-counter (OTC) omeprazole in a tier-copayment drug benefit design that favored the OTC drug. METHODS: The policy change in the Arkansas State Employee Benefit Division (EBD) involved 2 principal parts: OTC omeprazole placed in a new OTC copayment tier (5 dollars) and an increase in pharmacy reimbursement to a 13 dollars dispensing fee for each OTC omeprazole prescription. The prescription claims database was used to examine utilization and cost data for beneficiaries who received prescriptions for a proton pump inhibitor (PPI) during the 2-month period (January and February 2004) preceding the change in policy to cover OTC omeprazole compared with the 2-month period following the policy change (March and April 2004). RESULTS: During the first week of the new policy (March 1-7, 2004), OTC omeprazole accounted for 47% of all PPI claims. From the third week through the end of the 2-month study period, OTC omeprazole represented 60% of PPI claims. This shift to OTC omeprazole from prescription PPIs produced EBD average savings of 40.86 dollars (40.5%) per PPI claim in the first 2 months after implementation of coverage of OTC omeprazole compared with the immediate previous 2-month period. The average copayment savings for EBD beneficiaries were 4.20 dollars (16.5%) per PPI claim. The average increase in pharmacy reimbursement was 118% (6.27 dollars per claim in the postperiod versus 2.88 dollars per claim in the preperiod). Despite a 17.2% increase in utilization as measured by days of PPI therapy per member per month (1.91 PMPM) in the postperiod versus 1.63 in the preperiod, EBD savings were 2.11 dollars (38.9%) PMPM. Based upon PMPM savings of 2.56 dollars in the second month of coverage of OTC omeprazole, annual savings would be about 3,978,240 dollars for average eligible membership of 129,500 in this state employee health plan. CONCLUSION: This policy change to include coverage of OTC omeprazole in the state employee drug benefit plan produced savings to the state of as much as 50% of the total cost of PPI drugs despite an apparent small increase in utilization of PPIs and an increase in pharmacy reimbursement of more than 100%. Plan beneficiaries realized significant savings on average for PPI drugs and particularly for each OTC omeprazole prescription.

Faculty perceptions of the Educating Pharmacy Students to Improve Quality (EPIQ) program.

OBJECTIVE: To investigate users' initial perceptions of and potential applications for the Educating Pharmacy Students and Pharmacists to Improve Quality (EPIQ) program, a 5-module education program designed to educate pharmacists and pharmacy students about quality improvement in pharmacy practice. METHODS: The 5-module EPIQ program was distributed to pharmacy faculty members, pharmacy practitioners, and other health professionals across the country upon request. A 6-item survey instrument was sent to the first 97 people who requested the program. RESULTS: Twenty-seven (56%) of the 55 respondents had reviewed the EPIQ program and 22 (82%) intended to use some or all of the content to teach about quality improvement or patient safety primarily in pharmacy management and medication safety courses. CONCLUSION: Initial perceptions of the EPIQ program were positive; however, further evaluation is needed after more extensive implementation of the program in pharmacy colleges and schools and other settings.