User testing and performance evaluation of the Electronic Quality Improvement Platform for Plans and Pharmacies.

OBJECTIVE: To user-test and evaluate a performance information management platform that makes standardized, benchmarked medication use quality data available to both health plans and community pharmacy organizations. SETTING: Multiple health/drug plans and multiple chain and independent pharmacies across the United States. EVALUATION: During the first phase of the study, user experience was measured via user satisfaction surveys and interviews with key personnel (pharmacists, pharmacy leaders, and health plan leadership). Improvements were subsequently made to the platform based on these findings. During the second phase of the study, the platform was implemented in a greater number of pharmacies and by a greater number of payers. User experience was then reevaluated to gather information for further improvements. RESULTS: The surveys and interviews revealed that users found the Web-based platform easy to use and beneficial in terms of understanding and comparing performance metrics. Primary concerns included lack of access to real-time data and patient-specific data. Many users also expressed uncertainty as to how they could use the information and data provided by the platform. CONCLUSION: The study findings indicate that while information management platforms can be used effectively in both pharmacy and health plan settings, future development is needed to ensure that the provided data can be transferred to pharmacy best practices and improved quality care.

The Pennsylvania Project: pharmacist intervention improved medication adherence and reduced health care costs.

Improving medication adherence across the health care system is an ingredient that is vital to improving patient outcomes and reducing downstream health care costs. The Pennsylvania Project, a large-scale community pharmacy demonstration study, evaluated the impact of a pharmacy-based intervention on adherence to five chronic medication classes. To implement the study, 283 pharmacists from a national community pharmacy chain were assigned to the intervention group. Collectively, they screened 29,042 patients for poor adherence risk and provided brief interventions to people with an elevated risk. Compared to a control group of 295 pharmacists who screened 30,454 patients, the intervention significantly improved adherence for all medication classes, from 4.8 percent for oral diabetes medications to 3.1 percent for beta-blockers. Additionally, there was a significant reduction in per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). This study demonstrated that pharmacist-provided intervention is a cost-effective tool that may be applied in community pharmacies and health care sites across the country.

Case study of the effects of office-based generic drug sampling on antibiotic drug costs and first-line antibiotic prescribing ratios.

BACKGROUND: Health plans and members benefit from the substitution of lower-cost drug therapies that achieve the same clinical outcomes as higher-cost drugs. Previous research suggests that generic sampling programs produce drug cost savings overall, but the effects attributable to acute therapies are unknown. Encouraging physicians to prescribe less expensive, first-line antibiotics may help reduce direct drug costs associated with prescribing potentially unnecessary, and more expensive, second-line agents. OBJECTIVES: To determine the effects of an automated, office-based generic drug sampling kiosk on (a) prescribing of first-line oral antibiotic agents as a ratio of total antibiotic prescribing and (b) average antibiotic drug cost per claim. METHODS: This managed care organization of 2.3 million members with pharmacy benefits collaborated with a vendor that developed an automated generic drug kiosk that allows for the dispensing of samples of generic medications within the prescriber's office. Among the samples contained in the kiosk were 6 generic, first-line oral antibiotics, representing 8 unique drug-strength options. Drug costs were defined as the ingredient cost of the drug claim, which includes plan cost, member cost share, and any dispensing fees or administrative program costs associated with the sampling program. In a difference-in-difference analysis, changes in outcome measures (antibiotic drug cost per claim and dispensing rates of first-line antibiotics) from 2003 (baseline year) to 2005 (post-implementation year) were compared among kiosk prescribers (n=179) and nonkiosk prescribers who were part of the same provider network (n=7,236). A cross-sectional analysis of the same outcome measures compared kiosk (n=396) and nonkiosk prescribers (n=10,267) in 2006. All statistical analyses were performed using t-tests of logtransformed data. RESULTS: The mean cost per claim dropped by $4.14 (12.3%) from $33.56 in 2003 to $29.42 in 2005 for the kiosk prescribers and by $3.35 (8.8%) from $38.26 in 2003 to $34.91 in 2005 for nonkiosk prescribers, but the mean change from 2003 to 2005 in the difference-in-difference analysis was not statistically significant (P=0.123). The first-line antibiotic prescribing ratio declined by 2.1 absolute points from 49.1% in 2003 to 47.0% in 2005 for the kiosk prescribers and by 3.4 points from 46.0% in 2003 to 42.6% in 2005 for the nonkiosk prescribers, but the difference- in-difference analysis showed that the change was not statistically significant (P=0.901). A cross-sectional analysis of 2006 data revealed significant differences between the kiosk prescribers versus their nonkiosk network counterparts for both first-line antibiotic prescribing rates (42.0% and 41.4%, respectively; P=0.028) and antibiotic cost per claim ($28.44 and $32.40, respectively; P<0.001). While the results of the cross-sectional analysis are statistically significant, the practical significance of the results is less evident. CONCLUSIONS: The benefits of including short-term medications such as first-line antibiotics in a generic drug sampling program are difficult to quantify, and the cost outcomes are unlikely on their own to justify generic drug sampling. However, acute (short-term) medications may be an effective part of an overall program to promote generic prescribing for all conditions.

Development of a multidimensional scale to measure work satisfaction among pharmacy faculty members.

OBJECTIVES: To develop a multidimensional scale to measure work satisfaction among pharmacy faculty members and determine its reliability and validity. METHODS: A literature review was used to assist in the generation of 36 statements that putatively comprise the satisfaction construct. The 25 items meeting a priori criteria in a modified Delphi procedure were included in a questionnaire sent by e-mail to 4,228 pharmacy faculty members. Principal axis factoring and scale purification procedures were used to identify a plausible factor structure. RESULTS: Using responses acquired from 885 pharmacy faculty members, 6 domains of work satisfaction were identified: resources for scholarship, institutional support and reward, requirements for tenure and promotion, availability of a graduate program, collegiality, and teaching environment. The overall measure demonstrated construct validity, while each domain subscale exhibited relatively high internal consistency reliability. CONCLUSIONS: The overall work satisfaction measure and each subscale derived from composite domains can be used to identify sources of discontent and/or track interventions designed to improve work satisfaction.

Job turnover intentions among pharmacy faculty.

OBJECTIVES: To determine the primary reasons why pharmacy faculty intend to remain or leave their current institution and why they left their most recent academic institution, and the relative contribution of various organizational and individual characteristics toward explaining variance in turnover intentions. METHODS: A survey instrument was e-mailed to pharmacy faculty members asking respondents to indicate up to 5 reasons for their intentions and up to 5 reasons why they left a previous institution. The survey also elicited perceptions on quality of work life in addition to demographic and institutional data, upon which turnover intentions were regressed using a forward-conditional procedure. Organizational commitment as a moderator of turnover intentions was regressed over the remaining variables not acting directly on employer intentions. RESULTS: Just over 1 in 5 respondents indicated intentions to leave their current academic institution. Excessive workload, seeking a new challenge, poor salary, and poor relationships with college or school administrators were frequently cited as reasons for leaving. Turnover intentions are influenced directly by department chair support and organizational commitment, which moderates various support and satisfaction variables. CONCLUSIONS: Pharmacy faculty members' decision to remain or leave an institution is dependent upon developing a sense of commitment toward the institution. Commitment is facilitated by support from the institution and department chair, in addition to a sense of satisfaction with the teaching environment.