Perceptions of metabolic syndrome management utilization in relation to patient experience and health-related quality of life.

Background: One factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes. Objectives: The study explored the influence of PEwP and PMU on the health-related quality of life (HRQoL) of people with MetS. Methods: Data on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square and ordinal regression tests were used to predict the association between PMU, PEwP, and HRQoL. Also, mediation analysis through Haye's model 4 explored the direct and indirect relationship of PMU and PEwP on HRQoL. Results: A total of 706 completed surveys were collected and used for analyses. On average, respondents reported three comorbidities. Of the respondents, 72.0% had good PEwP, while 32.6% had good PMU. Comparatively, 38.4% of those with good PEwP had good PMU, compared to 17.3% of those with poor PEwP. Also, 47.0% of those with good PMU had good HRQoL compared to 35.3% with poor PMU. The odds of having fair or good PMU were nearly triple (OR = 2.97, p < 0.001) among those with good PEwP compared to those with poor PEwP. Also, respondents with good PMU had 58% (OR = 1.58, p = 0.008) higher odds of having fair or good HRQoL. Analysis through bootstrap indicated a significant relationship (BootCI = -0.072, -0.022) between PEwP and HRQoL via respondents' PMU. Conclusions: MetS individuals with good experience and PMU were more likely to have good HRQoL. Prior experience with pharmacists influenced PMU and indirectly impacted HRQoL. Therefore, pharmacists must consider patients' experience and management utilization perceptions to promote health outcome among people with MetS, while implementing interventions.

Recommitting to AACP Engaged Governance for the Common Good: Report of the 50th Anniversary Commission to Reimagine the AACP House of Delegates.

The 50th Anniversary Commission to Reimagine the American Association of Colleges of Pharmacy (AACP) House of Delegates (HOD Commission) was charged to consider and recommend changes to the AACP Board of Directors and AACP HOD regarding a broad range of issues related to the HOD. The 2021-2022 HOD Commission met virtually many times throughout the year as 2 sub-groups and a full commission, using Basecamp for shared documents and timelines, and it provided interim reports to the Board of Directors in November and February. A survey of 2022 delegates was developed and administered; responses from 163 delegates informed final recommendations as described in the report. The HOD Commission affirms the need for and purpose of AACP's HOD and urges that all schools/colleges of pharmacy recommit to engaged governance for the common good.

Disentangling the Cost of Orphan Drugs Marketed in the United States.

The increasing number and high prices of orphan drugs have triggered concern among patients, payers, and policymakers about the affordability of new drugs approved using the incentives set by the Orphan Drug Act (ODA) of 1983. This study evaluated the factors associated to the differences in the treatment cost of new orphan and non-orphan drugs approved by the FDA from 2017 to 2021. A generalized linear model (GLM) with the Gamma log-link analysis was used to ascertain the association of drug characteristics with the treatment costs of orphan and non-orphan drugs. The results of the study showed that the median and interquartile range (IQR) drug cost was USD 218,872 (IQR = USD 23,105) for orphan drugs and USD 12,798 (IQR = USD 57,940) for non-orphan drugs (p < 0.001). Higher market entry prices were associated with biologics (108%; p < 0.001), orphan status (177%; p < 0.001), US sponsor companies (48%; p = 0.035), chronic use (1083%; p < 0.001), treatment intent (163%; p = 0.004), and indications for oncology (624%; p < 0.001) or genetic disorders (624%; p < 0.001). Higher market entry treatment cost for newly approved drugs were associated with biologics, orphan status, US sponsor companies, chronic use, therapeutic intent, and indications for oncology or genetic disorders.

Influence of patient-pharmacist relationship on willingness to accept pharmacist-provided services.

BACKGROUND: Willingness to accept various pharmacist-provided services such as health promotion and medication management is still considered low. Evidence suggests that patient experience and socio-demographics partially explain patient willingness to use pharmacy services. However, the influence of a patient's relationship with their pharmacist may provide additional explanatory power. OBJECTIVES: The aims of the study were to [1] explore the willingness to accept pharmacy services across patients' relationship with pharmacists and [2] evaluate the association between the patient-pharmacist relationship and patients' willingness to accept pharmacist-provided services. METHODS: A total of 1521 respondents' data on the types of patient-pharmacist relationships and willingness to accept dispensing, drug information, medication management, and health promotional services were collected from the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Willingness scores across the groups were evaluated using chi-square and analysis of variance. Binary logistic regression was used to investigate the associations between patient-pharmacist relationships and willingness to accept pharmacist-provided services. RESULTS: More respondents were "definitely willing" to accept dispensing services (68.5%) and drug information (68.3%), while 56.5% and 50.1% were "definitely willing" to accept health promotion and medication management services, respectively. While respondents with "customer" and "client" archetype relationships were definitely willing to accept the 4 categories of pharmacy services, the highest proportion of respondents definitely willing to accept the services was observed among those with "partner" archetype relationships. Willingness scores increased significantly across the archetype relationships. Respondents with a "partner" archetype relationship had the highest and most significant odds ratio of accepting all the categories of pharmacist-provided services. CONCLUSION: Willingness to accept services from pharmacists increased as the level of the patient-pharmacist relationship grew. Patients in "partner" archetype relationship were significantly more likely to accept all categories of pharmacist-provided services. Pharmacists are encouraged to embrace the patient-pharmacist relationship continuum to optimize patient care.

Investigation of predictors influencing patient-pharmacist relationship establishment.

BACKGROUND: A strong patient-pharmacist relationship is tied to patients' trust and confidence in pharmacists and pharmacy services. While past research has described patient-pharmacist relationship archetypes (i.e., "customer," "client," "partner") with potential to help pharmacists initially understand patients' preferences and expectations of care and services, little is known about potential factors that underlie these preferences and expectations. OBJECTIVES: This study was aimed to [1] compare the prevalence of the current and desired patient-pharmacist relationships archetypes reported by patients and [2] identify the sociodemographic, health, and medication use and procurement factors predictive of the archetypes representing patients' current relationship with outpatient pharmacists. METHODS: Data from 1521 patients were collected via the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Patient-pharmacist relationship distribution across patients' sociodemographic characteristics was explored using crosstabulations. Multinomial logistic regression was also used to investigate the association between patient sociodemographic characteristics and the current patient-pharmacist archetype relationships. RESULTS: The mean age of the patients was 53.9 years and 57.3% were married. Thirty-two percent of the patients reported currently having a "Customer" relationship, while 17.9% and 15.2% reported having a "Client" and "Partner" archetype relationship, respectively. "Client" (25.2%) and "Partner" (20.2%) relationships were the most commonly preferred archetypal relationships. The odds ratios (OR) of having "Client" or "Partner" relationships increased with the number of patients' health conditions and medications. Patients who visited independently owned and clinic pharmacies had a higher OR of building professional relationships with a pharmacist. CONCLUSION: The qualities of a patient-pharmacist relationship may be associated with key patient characteristics. Pharmacists can build relationships with patients informed by a continuum of patient preferences, expectations, and needs to optimize health outcomes.

Cost-effectiveness analysis of androgen deprivation therapy with relugolix for the treatment of advanced prostate cancer.

BACKGROUND: Relugolix treatment of advanced prostate cancer (APC), like other gonadotropin-releasing hormone-antagonists, results in rapid decrease in testosterone concentrations without the risk of flare, as seen in leuprolide. Despite this benefit over leuprolide, no economic evaluation assessment to ascertain the cost-effectiveness of relugolix has been conducted. Therefore, this study aims to assess the cost-effectiveness of androgen deprivation therapy (ADT) with 120 mg relugolix against 7.5 mg leuprolide for the treatment of APC. METHODS: A Markov model was used to assess and compare the costs of APC treatment from a health care payer's perspective and the effectiveness of ADT with relugolix and leuprolide at the 3 lines of APC treatment among modified intent-to-treat patients. Relative progression-free (PFS) and overall survival (OS) rates were estimated. Outcomes measured in the analyses included costs of the drugs and therapies, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), cost-effectiveness acceptability, and probability curves. RESULTS: The cost-effectiveness analysis showed the ICER for ADT with relugolix to be US $49,571.1 per QALY. At the ICER value, the sensitivity analysis indicated that ADT with leuprolide was dominant in 100% of the simulations. ADT acceptance with relugolix was 100% when a willingness-to-pay threshold was set at US $100,000/QALY. At 5-years, the relative PFS and OS rates for relugolix at the first line of therapy were 72.7% and 86.0%, respectively, compared to 61.0% and 85.90% for leuprolide. CONCLUSION: Though the influence of adverse events was not considered in the analysis, ADT with relugolix was not a cost-effective choice for APC management. While the analysis revealed a slight chance of sustaining testosterone suppression with relugolix, ADT with relugolix provided no significant survival advantages over ADT with leuprolide. Therefore, this analysis confirms no need for further assessment of APC interventions to make informed decisions beneficial to the APC patients, oncologists, and other stakeholders.

Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles.

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020-January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure-e.g., inequitable access to public benefits-may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.

Financial hardship from purchasing prescription drugs among older adults in the United States before, during, and after the Medicare Part D "Donut Hole": Findings from 1998, 2001, 2015, and 2021.

BACKGROUND: Cost-related nonadherence compromises successful and effective management of chronic disease. The Medicare Modernization Act of 2003 (MMA) and Patient Protection and Affordable Care Act of 2010 (ACA) aimed to increase the affordability of outpatient prescription drugs for older adults (older than age 64 years). The Medicare Part D prescription drug insurance coverage gap ("donut hole") created by the MMA was fully closed in 2020 by the ACA. OBJECTIVES: To (1) describe prescription drug coverage and financial hardship from purchasing prescription drugs among older American adults for 2021, (2) compare these results with findings from data collected before the MMA and during the progressive elimination of the Medicare Part D coverage gap, and (3) compute the likelihood for financial hardship from purchasing prescription drugs using variables for year, prescription drug insurance coverage, health-related information, and demographics. METHODS: Data were obtained from 4 nationally distributed, crosssectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs. Surveys in 1998 and 2001 were mailed to national random samples of US seniors. Of 2,434 deliverable surveys, 700 (29%) provided useable data. Data were collected in 2015 and 2021 via online surveys sent to samples of US adults. Of 27,694 usable responses, 4,445 were from older adults. Descriptive statistics and logistic regression analyses described relationships among financial hardship and demographics, diagnoses, and daily prescription drug use. RESULTS: Five percent of older adults lacked prescription drug coverage in 2021, continuing a downward trend from 32% in 1998, 29% in 2001, and 9% in 2015. Contrastingly, 20% of older adults reported financial hardship from prescription drug purchases in 2021, bending an upward trend from 19% in 1998, 31% in 2001, and 36% in 2015. Financial hardship from purchasing prescription drugs was more likely to be reported by older adults lacking prescription drug insurance, taking multiple medications daily, and having a low annual household income across all survey years. The latter 2 of these 3 factors were still predictive of financial hardship from purchasing prescription drugs among older adults with prescription drug insurance. CONCLUSIONS: Financial hardship from purchasing prescription drugs is still experienced by many older adults after the full implementation of the MMA and ACA. Lacking prescription drug coverage, taking more than 5 prescription drugs daily, and a low annual household income may increase the likelihood of experiencing this financial hardship. Pharmacists can be a resource for older adults making choices about their prescription drug coverages and purchases. DISCLOSURES: Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, the Peters Endowment for Pharmacy Practice Innovation, the Chapman University Research Program, and the University Minnesota Research Program.

Patient characteristics associated with the use of pharmacist-administered vaccination services and predictors of service utilization.

BACKGROUND: Data on the impact of pharmacists as vaccinators are available; however, research on understanding the characteristics of users of pharmacist-administered vaccinations is scarce. OBJECTIVES: This study aimed to identify the characteristics of the users of pharmacist-administered vaccinations and recognize predictors of utilizing these services. METHODS: Data were obtained from a cross-sectional online survey, and the sample size was 26,173 respondents from all over the United States. The outcome measure was the previous use of pharmacist-administered vaccination. Independent variables were demographic factors, health-related factors, and previous utilization of pharmacy products and services. Chi-square test and multivariable logistic regression analyses were conducted to examine the factors associated with the use of this service. P values, odds ratios (ORs), and 95% CIs were computed and reported. RESULTS: About 31% of respondents reported previous use of pharmacist-administered vaccination. The gender of respondents was mainly female (71.2%), and the race was mainly white (80.7%). Chi-square analysis showed a statistically significant association of service use with age, education, geographic region, use of other pharmacy services and products, type of pharmacy, and the number of chronic diseases (P < 0.05). Logistic regression analysis showed a statistically significant association with the number of chronic diseases (OR 1.085 [95% CI 1.049-1.122]), level of education (1.352 [1.35-1.28]), race (0.901 [0.840-0.969]), and proximity to pharmacy (0.995 [0.992-0.997]). Age, type of pharmacy, and previous use of other pharmacist-provided services and products also showed statistically significant associations (P < 0.05). CONCLUSION: The use of pharmacist-administered vaccination has been increasing over the past years. The service has many advantages compared with other vaccination service providers and associated with higher vaccination rates among people with older age, higher education, and a higher number of chronic diseases. With proper training and education, pharmacists are unique in improving vaccination services and public health in general.

Predisposing, Enabling, and Need Factors Associated with the Choice of Pharmacy Type in the US: Findings from the 2015/2016 National Consumer Survey on the Medication Experience and Pharmacists' Roles.

BACKGROUND: Knowing the type of pharmacy used by the patient is meaningful to the pharmacist. Previous studies have assessed different factors predicting the kind of pharmacy selection and reached inconsistent findings. OBJECTIVES: To identify patient and health-related factors associated with pharmacy type selection. METHODS: The Andersen Behavioral Model of Health Service Use was used to organize the selection of patient characteristics and categorize them as predisposing, enabling, and need factors. The dependent variable was the type of pharmacy used. Logistic regression was used to predict the association between patient-related characteristics and the type of pharmacy used. RESULTS: Older age respondents were less likely to use independent pharmacies (OR = 0.992) and more likely to use mail pharmacy services (OR = 1.026). Highly educated people showed higher use of chain and mail pharmacies (OR = 1.272, 1.185, respectively) and less tendency to use the independent, supermarket, and prescription-only pharmacy types. Men were less likely to use chain pharmacies (OR = 0.932) and more likely to use supermarket pharmacies than women. Patients who use Medication Therapy Management (MTM) services had higher odds of using independent and supermarket pharmacies (OR = 2.808, 1.689, respectively). Patients with a higher number of chronic diseases and experienced side effects of medications were more likely to use independent pharmacies (OR for number of disease = 1.097 and for side effects = 1.095). CONCLUSIONS: This study's findings identify characteristics associated with selecting certain pharmacy settings and direct future research to include other predictors encompassing beliefs, attitudes, and other social factors.

Use of the Jung/Myers Model of Personality Types to Identify and Engage with Individuals at Greatest Risk of Experiencing Depression and Anxiety.

Depression is the leading cause of ill health and disability worldwide. Objectives were (1) to determine the strength of the association between personality type with depression and anxiety using the Preferred Communication Style Questionnaire (PCSQ©) and the Four-Item Patient Health Questionnaire for Depression and Anxiety (PHQ-4) and (2) evaluate the extent to which severity of depression and anxiety is associated with personality type. Data were collected via a self-administered online survey of 10,500. Chi-square analysis compared personality types and depression and anxiety. Practical significance was determined by calculating the percentage-from-expected score based on established statistics reflecting each personality type's percentage in the US population. Personality type was strongly associated with both depression and anxiety with certain types at significantly greater risk than others. Findings can improve the research and clinical community's understanding of the specific risk factors and triggers for depression and anxiety, and result in more efficacious, tailored treatment options.

Use of National Consumer Survey Data to Explore Perceptions of Complementary and Alternative Medicine.

BACKGROUND: Although Complementary and Alternative Medicine (CAM) has been the standard of therapy in Asia for centuries, it started receiving more attention in the U.S. in the last three decades. OBJECTIVES: The primary study objective was to explore individuals' perspectives of CAM. A secondary objective was to describe individuals' perceptions of pharmacists' roles in facilitating their use of these services and products. METHODS: Data were obtained from the 2015 and 2016 National Consumer Surveys on the Medication Experience and Pharmacist Roles. Data were collected from adults residing in the United States via on-line, self-administered surveys coordinated by Qualtrics Panels between April 28 and June 22, 2015 (n = 26,173) and between March 14 and 30, 2016 (n = 10,500). This study focused on written comments made in the surveys with Content Conventional Analysis applied to the text. Four researchers were trained to conduct coding to assess inter-judge reliability. The four judges had a high level of agreement which was greater than 0.95 for category type. RESULTS: Out of a total of 36,673 respondents, 80% (29,426) submitted written comments at the end of the survey. Of these, 2,178 comments were about medications or health and 170 (8%) comments specifically about CAM, of which 136 (6%) were usable for analysis. Conventional Content Analysis revealed five themes:1)The role of pharmaceutical and insurance companies in CAM; 2) Overuse of medications; 3)Physicians can play a role in creating a balance between prescription use and CAM; 4) Individuals believe that CAM is more effective than Western medicines and prefer it; 5) Individuals want pharmacists to have a better understanding of CAM. Theresults of this study reveal individuals' opinions regarding how they want CAM to be considered in their interactions with their healthcare team. CONCLUSION: Emergent themes suggest that individuals are interested in receiving more professionals' healthcare to become more knowledgeable about CAM.

Work Profile Factors Identified From the Career Pathway Evaluation Program, 2018 Pharmacist Profile Survey.

Objective. To identify work profile factors from the Career Pathway Evaluation Program, 2018 Pharmacist Profile Survey. Methods. Exploratory factor analysis was used to describe the underlying structures (factors) that best represented respondents' work profiles. Descriptive statistics and Analysis of Variance were used to describe the 17 different work categories listed in the survey. Results. Eleven underlying factors were identified for the respondents' work setting profiles. A description of these factors among the 17 different respondent career categories revealed variation that can be useful in describing the career categories in the APhA Career Pathway Evaluation Program for Pharmacy Professionals. Conclusion. The results revealed variation among pharmacist career types. The profiles constructed in this study describe the characteristics of various career paths and can be helpful for decisions regarding educational, experiential, residency, and certification training in pharmacist careers.

An Opportunity for Pharmacists to Help Improve Coordination and Continuity of Patient Health Care.

Pharmacist workforce researchers are predicting a potential surplus of pharmacists in the United States that might result in pharmacists being available for engagement in new roles. The objective for this study was to describe consumer opinions regarding medication use, the health care system, and pharmacists to help identify new roles for pharmacists from the consumer perspective. Data were obtained from the 2015 and 2016 National Consumer Surveys on the Medication Experience and Pharmacist Roles. Out of the representative sample of 36,673 respondents living in the United States, 80% (29,426) submitted written comments at the end of the survey. Of these, 2178 were specifically about medicines, pharmacists or health and were relevant and usable for this study. Thematic analysis, content analysis, and computer-based text mining were used for identifying themes and coding comments. The findings showed that 66% of the comments about medication use and 82% about the health care system were negative. Regarding pharmacists, 73% of the comments were positive with many commenting about the value of the pharmacist for overcoming fears and for filling current gaps in their healthcare. We propose that these comments might be signals that pharmacists could help improve coordination and continuity for peoples' healthcare and could help guide the development of new service offerings.

Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States.

OBJECTIVE: To describe the prevalence of herbal medicine use among US adults and to assess factors associated with and predictors of herbal use. DESIGN: The data for herbal products use were collected from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles. Chi-square test was used to analyz factors associated with herbal use, and predictors of herbal use were assessed with logistic regression analysis. RESULTS: Factors associated with herbal supplement use include age older than 70, having a higher than high school education, using prescription medications or over-the-counter (OTC) medications, and using a mail-order pharmacy." All Disease state associated significantly with herbal use. Approximately thirty-eight percent of those who used herbals used prescription medications and 42% of those who used herbals also used an OTC medication. The most frequent conditions associated with herbal supplement use were a stroke (48.7%), cancer (43.1%), and arthritis (43.0%). Among herbal product users, factors that predicted use included having higher than school education, using OTC medications, using mail-order pharmacy, stroke, obesity, arthritis, and breathing problems. CONCLUSIONS: More than one-third of respondents reported using herbal supplements. Older age and higher education were associated with a higher use of herbal supplements. People with chronic diseases are more likely to use herbal medicines than others. OTC drug users and patients with stroke are more likely to use herbal medicines than others.

The certainty in consumers' willingness to accept pharmacist-provided medication therapy management services.

OBJECTIVES: To describe consumers' willingness to accept medication therapy management (MTM) services provided by a pharmacist. DESIGN: Cross-sectional Internet survey included questions about willingness to use 11 components of MTM services. PARTICIPANTS: The data of 8352 United States' adults who were on 3 or more medications were obtained from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles, which included 26,173 respondents. MAIN OUTCOME MEASURES: Respondents used a scale that ranged from "definitely would not accept" to "definitely would accept" to specify their willingness to use each of the MTM components. RESULTS: The mean age was 53.1 years, with an average of 1.9 health problems and 5.4 prescription medications. About 50% of respondents definitely would accept 6 or more MTM components. The services with the highest rates of "definitely would accept" were "Recommend the use of a generic drug to help save money" and "Provide advice in administering medications as prescribed" (65.4% and 64.2%, respectively). The next highest were "Performing a review of all medications to make sure they are effective, safe, and affordable" and "Recommendation of nonprescription medications to take care of mild ailments or discomforts" (57.0% and 56.4%, respectively). Those who definitely would accept MTM services, compared with those who would not, differed in terms of gender, education level, income, medication insurance coverage, ever having been a pharmacist, and number of health problems. CONCLUSION: The majority of United States' adults expressed a certain willingness to accept most of the components of MTM services. More research needs to be done to understand why certain groups were less willing to accept MTM services.

Consumers' characteristics associated with the use of mail pharmacy services in the United States: Findings from the 2015 National Consumer Survey on the Medication Experience.

OBJECTIVES: The purpose of this study was to describe current users of mail pharmacy services and to evaluate factors associated with the use of mail pharmacy services. DESIGN: Cross-sectional online survey-based study. SETTING AND PARTICIPANTS: The data were obtained from the 2015 National Consumer Survey on the Medication Experience, which included 26,173 adults from throughout the United States. OUTCOME MEASURES: Mail pharmacy utilization was based on participant self-report. Demographic variables included age, education, race, gender, insurance status, distance to nearest pharmacy, number of disease states, and income. Chi-square and t test analyses were conducted to assess the factors associated with mail pharmacy use. Multivariable logistic regressions were used to compute the odds ratios (ORs) and 95% confidence intervals for the predictors of mail pharmacy usage. RESULTS: Overall, 17% of respondents reported the use of mail pharmacy services. Based on chi-square analysis, use of mail pharmacy services was significantly associated with age, education, race, and region. In addition, distance to nearest pharmacy and the report of the presence of certain disease states were significantly associated with mail pharmacy use (P <0.001). Based on the results of logistic regression analysis, there was a significant association of mail pharmacy use by age, having chronic diseases, level of education, distance to nearest pharmacy, and other included variables (P <0.05). CONCLUSION: Mail pharmacy service users accounted for 17% of the respondents of this study. Advancing age, presence of chronic diseases, increasing level of education, and increasing distance to the nearest pharmacy were positively associated with the use of mail pharmacies. Further research is needed to better understand patient-specific reasons for choosing mail pharmacies or community pharmacies.

Financial Hardship from Purchasing Medications for Senior Citizens Before and After the Medicare Modernization Act of 2003 and the Patient Protection and Affordable Care Act of 2010: Findings from 1998, 2001, and 2015.

BACKGROUND: The Medicare Modernization Act of 2003 (Medicare Part D) added prescription drug coverage for senior citizens aged 65 years and older and applied managed care approaches to contain costs. The Patient Protection and Affordable Care Act of 2010 (ACA) had the goals of expanding health care insurance coverage and slowing growth in health care expenditures. OBJECTIVES: To (a) describe the proportion of senior citizens who had prescription drug insurance coverage and the proportion who experienced financial hardship from purchasing medications in 2015, and (b) compare the findings with those collected in 1998 and 2001. METHODS: Data were obtained in 1998 and 2001 via surveys mailed to national random samples of seniors. Of 2,434 deliverable surveys, 946 (39%) were returned, and 700 (29%) provided usable data. Data were collected in 2015 via an online survey sent to a national sample of adults. Of 26,173 usable responses, 3,933 were aged 65 years or older. Descriptive statistics and logistic regression analyses described relationships among study variables. RESULTS: Results showed that the proportion of seniors without prescription coverage was 9% in 2015, a decrease from 29% in 2001 and 32% in 1998. The proportion of senior citizens reporting financial hardship from medication purchases was 36% in 2015, a rise from 31% in 2001 and 19% in 1998. For those without prescription drug coverage, 34%, 55%, and 49% reported financial hardship in 1998, 2001, and 2015, respectively. For those with drug coverage, 12%, 22%, and 35% reported financial hardship in 1998, 2001, and 2015, respectively. CONCLUSIONS: After implementation of Medicare Part D and the ACA, the proportion of seniors without prescription drug coverage decreased. However, self-reported financial hardship from purchasing medications increased. Senior citizens with prescription drug insurance may be experiencing financial hardship from increasing out-of-pocket costs for insurance premiums, cost sharing, and full-cost obligation for some medications. DISCLOSURES: Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, and the Peters Endowment for Pharmacy Practice Innovation. The authors have no conflicts of interest to declare. Schommer, Mott, and Brown contributed to study design and collected the data, with assistance from Olson. Data interpretation was performed by Olson, Schommer, Mott, and Brown. The manuscript was written and revised by Olson, Schommer, Mott, and Brown.

Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly.

Medicare Part D improved medication adherence among the elderly, but to date, its effect on disparities in adherence remains unknown. We estimated Part D impact on racial/ethnic disparities in adherence to cardiovascular medications among seniors, using pooled data from the Medical Expenditure Panel Survey (2002-2010) on 14,221 Medicare recipients (65+ years) and 3,456 near-elderly controls (60-64 years). Study sample included White, Black, or Hispanic respondents who used at least one cardiovascular medication. Twelve-month adherence was measured as having an overall proportion of days covered ≥80%. Adherence disparities were defined according to the Institute of Medicine framework. Using difference-in-differences logistic regression, we found Part D to be associated with a 16-percentage-point decrease in the White-Hispanic disparity in overall adherence among seniors, net of the change among controls. Black-White disparities worsened only among men, by 21 percentage points. Increasing access and improving quality of medication use among disadvantaged seniors should remain a policy priority.

Exploring the variation in state-level prescription utilization using a triangulation of analytic methods.

BACKGROUND: Retail prescription fill data have consistently shown wide variation in prescription drug utilization across states, with state-level rates ranging from 8.5 to 19.3 filled prescriptions per capita per year. Empirical explanations for this wide variation have not yet been sought. OBJECTIVES: To examine which factors potentially explain the wide variation in prescription drug utilization across US states. METHODS: Summary data (proportions, counts, rates, etc) on sociodemographics, health, insurance, provider density, health service use, and retail prescription drug fills for each of the 50 states and the District of Columbia, from 2008 to 2010, were retrieved from multiple national data sources, such as the Kaiser Family Foundation's "State Health Facts" Web Portal. Pooled cross-sectional linear, negative binomial, and ordered logit multivariable regressions were used to model states' prescription utilization as a function of the aforementioned possible explanatory variables. Principal components analysis also was employed so as to overcome high correlations among some of the covariates. RESULTS: Among US states, higher levels of employer-sponsored insurance or Medicaid coverage were associated with both higher levels of prescription utilization and a higher likelihood of being in upper utilization quartiles. A higher density of nurse practitioners was also positively associated with both the level of utilization and the likelihood of higher utilization, whereas a higher density of active physicians was associated with opposite effects. Higher prevalence of physical activity was associated with lower utilization levels as well as a lower likelihood of high utilization. State-level prevalence of chronic conditions and poor health mattered only for the level of prescription utilization. States' sociodemographics were not significantly associated with prescription utilization. CONCLUSIONS: This study suggests that higher prescription utilization across states was associated with the variations in provider types, Medicaid and private insurance coverage, as well as the prevalence of chronic diseases. Further investigation of how each of these factors may contribute to a particular state's prescription drug utilization level is needed.