Practice models used by pharmacists in rural Minnesota to obtain Medicare reimbursement.

OBJECTIVES: (1) Define "incident-to" rules for Medicare reimbursement; (2) Describe how pharmacists can meet incident-to rules; (3) Provide examples of models of practice in rural areas that could be useful for meeting incident-to rules; and (4) Develop a strategy for creating a pharmacy practice model that could meet Medicare reimbursement rules in rural areas. DESIGN AND PARTICIPANTS: A survey of participants from the Pharmacy Rural Education, Practice and Policy Institute and the College of Pharmacy, University of Minnesota. SETTING: Community, hospital, and clinic practice sites in rural Minnesota. RESULTS: Four distinct models of practice have evolved that meet the incident-to rules of Medicare for reimbursement. Travel, proximity to physicians, and employment are the major determinants of the models described. CONCLUSION: Pharmacists in rural areas have demonstrated the ability to satisfy the incident-to rules for Medicare reimbursement. Collaborative agreements with physicians must include specific employment, practice, and supervisory relationships in order to satisfy these rules.

Effect of multiple-source entry on price competition after patent expiration in the pharmaceutical industry.

OBJECTIVE: To analyze the effect of multiple-source drug entry on price competition after patent expiration in the pharmaceutical industry. DATA SOURCES: Originators and their multiple-source drugs selected from the 35 chemical entities whose patents expired from 1984 through 1987. Data were obtained from various primary and secondary sources for the patents' expiration dates, sales volume and units sold, and characteristics of drugs in the sample markets. STUDY DESIGN: The study was designed to determine significant factors using the study model developed under the assumption that the off-patented market is an imperfectly segmented market. PRINCIPAL FINDINGS: After patent expiration, the originators' prices continued to increase, while the price of multiple-source drugs decreased significantly over time. By the fourth year after patent expiration, originators' sales had decreased 12 percent in dollars and 30 percent in quantity. Multiple-source drugs increased their sales twofold in dollars and threefold in quantity, and possessed about one-fourth (in dollars) and half (in quantity) of the total market three years after entry. CONCLUSION: After patent expiration, multiple-source drugs compete largely with other multiple-source drugs in the price-sensitive sector, but indirectly with the originator in the price-insensitive sector. Originators have first-mover advantages, and therefore have a market that is less price sensitive after multiple-source drugs enter. On the other hand, multiple-source drugs target the price-sensitive sector, using their lower-priced drugs. This trend may indicate that the off-patented market is imperfectly segmented between the price-sensitive and insensitive sector. Consumers as a whole can gain from the entry of multiple-source drugs because the average price of the market continually declines after patent expiration.

Correlation of employees' perception of workload with workload indicators.

In this study, the measurement of perception of pharmacists' workload did not correlate well with any workload indicators studied. Generally, census on the study date correlated well for pharmacy technicians working in various areas of the pharmacy. If it is agreed that perception of workload is the real measure of activity--that is, how busy the employees believe it is--then the indicators used in this study are not useful. Similar research using other indicators is warranted.

Purdue stepped approach model: application to pharmacy practice.

The Purdue Stepped Approach Model (PSAM) of service delivery is applied to pharmacy practice. The PSAM offers a method to organize interventions in a systematic and sequential manner according to the amount and type of resources required to achieve optimal patient health status. The model also provides an approach to integrating the expertise of other healthcare professionals into the provision of pharmacy services (e.g., health educators, psychologists, nurse practitioners, exercise physiologists), addresses economic costs and differential modes of reimbursement, and provides suggestions for future research. Examples are included to facilitate application of the PSAM in pharmacy and implications for holistic healthcare or health promotion in pharmacy practice are discussed.

Home use of rectal diazepam for cluster and prolonged seizures: efficacy, adverse reactions, quality of life, and cost analysis.

From 1982 through 1987, 128 families, who were instructed in the use of rectally administered diazepam (R-DZP) for the treatment of severe epileptic seizures, were surveyed. Sixty-seven families returned questionnaires and met inclusion/exclusion criteria; the results were used to analyze the medical, psychosocial, and economic impact of this program during the first year following instruction. Twenty-six families did not use R-DZP, primarily because of patient improvement. Among families using R-DZP, a total of 428 doses were administered to 41 children. R-DZP was effective in controlling seizures in 85% of patients. Adverse reactions usually were mild, consisting of drowsiness and/or behavioral changes. Compared to the year prior to instruction, emergency room visits decreased in both R-DZP-treated and -nontreated children; however, cost-savings were greater for the R-DZP group ($1,039.00 vs $420.00 per patient per year). Improvements in quality of life associated with the availability of R-DZP were observed by 58% of users and 27% of nonusers which included improved management of their children's seizures, increased flexibility in family activities, and greater peace of mind. R-DZP appears to be a practical method in the effective treatment of severe seizures at home.

Household survey of child-safe packaging for medications.

In an investigation of the prevalence of safety packaging of medications, 131 randomly selected Minneapolis and St. Paul households with children were surveyed in 1985. Of the 1,953 oral medications in these households (mean was 14.9 per home), 43.3 percent did not have safety packaging. Over-the-counter medications were less likely to have safety packaging than prescription medications (over-the-counter 53.1 percent, prescription 25 percent). This high prevalence of medications without safety packaging in households with children could increase the risk of childhood poisoning. Strategies to reduce this potential risk are discussed.

Career patterns of pioneer clinical pharmacists.

The career paths of some early clinical pharmacists from their first positions during the years 1965-1974 to their current positions were studied. In August 1985 a group of pharmacists was surveyed to determine (1) the extent to which they had maintained a clinical practice (defined as direct patient contact, including evaluating and planning drug regimens), (2) the number of job-function changes, and (3) the degree of the pharmacists' commitment to public service, as measured by Hall's Belief in Public Service and Allport-Vernon-Lindzey Personality Values. The response rate for the 337 questionnaires was 73.5%. The average age of the group was 40 years; 83% were men, and 79% possessed Doctor of Pharmacy degrees. The respondents had changed job functions an average of 2.1 +/- 1.5 times over the last 13 years since the highest professional degree. The percentage in the job functions of hospital pharmacist and pharmacy faculty declined over time while those in hospital pharmacy administration, academic administration, and the pharmaceutical industry increased. Clinical-practice activity declined over time, with a twofold net increase in those reporting no direct patient-care responsibilities. Male respondents with fewer years after their highest professional degree, a greater belief in public service, higher theoretical values, and no residency experience were more likely to be currently involved in direct patient care than others. Although attrition among pioneer clinical pharmacists is not excessive for those who began their careers with a relatively small percentage of their time devoted to clinical practice, most pharmacists who began with substantial clinical commitments have reduced or eliminated clinical activities over time.(ABSTRACT TRUNCATED AT 250 WORDS)

ASHP members' concepts of institutional pharmacy in the year 2000.

Trends in institutional pharmacy practice were identified, and ASHP members' views of these trends were evaluated in a futures study. A list of statements concerning the practice of institutional pharmacy in the year 2000 was developed using a modified Delphi method. A random sample of 3000 active ASHP members received the questionnaire and were asked to estimate the probability that each of the 42 statements would occur by the year 2000. The responses were analyzed to reduce the number of variables to common factors. A total of 1276 of the returned questionnaires were usable. Six factors were identified: pharmacy-medicine linkage, advanced training or degree, drug administration, quality assurance and accreditation, supportive personnel, and pharmacy-nursing conflict. There were differences in the mean values of responses of items related to various factors when they were compared by sex, age, position held, degree held, and residency training. The key trends predicted were that advanced training or degrees will be necessities in the year 2000, institutional practice will be composed of multiple tracks, postgraduate education will be required of clinicians and administrators, turf conflict with nurses will increase, and accreditation standards and other safeguards for quality health care will continue to be required and will increase. The trends in how ASHP members conceptualized the future of their profession can provide insight for individuals developing programs in pharmacy education, health-care administration, institutional practice, and the pharmaceutical industry.

Predicting success of pharmacy students in basic science and clinical clerkship courses.

A number of studies on the ability of admissions variables to predict success in pharmacy schools have examined only success in the first professional year, which typically consists primarily of basic science courses. This study examined not only grades in basic science courses but also performance on clinical clerkships, for two classes of students. It also examined the ability of various personality variables to predict performance in clinical and basic science coursework. Previous grade point average (GPA) was the best single predictor of performance. In one class, the personality variable of Responsibility best predicted clinical clerkship performance. However, it only accounted for 13 percent of the variance in clerkship grades. Pharmacy College Admission Test (PCAT) Biology and PCAT Verbal Ability scores added to the predictive ability of previous GPA in one class, but none of the PCAT scales entered a prediction equation for the other class. The limitations on our ability to predict, with any consistency, academic performance in pharmacy school is discussed.

The effect of Medicaid on the quantity of drugs dispensed per prescription.

Several studies have been conducted in order to determine the effect of the Medicaid program on drug utilization. This paper describes a research project that attempted to determine whether the Medicaid program has any effect on the quantity of drugs dispensed per prescription. A sample of privately paid prescriptions was compared to all Medicaid prescriptions in Iowa during the fiscal year 1972-73. A randomized block design for analysis of variance was used. The results showed that, overall, the quantity prescribed per patient was greater in the Medicaid population than for the privately paying sample. However, when broken down by therapeutic category, 4 of the 15 drug classes examined displayed higher quantities in the privately paying sample. These four categories were classified as maintenance drugs.

Factors related to the prescribing of selected psychotropic drugs by primary care physicians.

The objective of this study were to investigate the influences of differing physician characteristics and attitudes on the diagnosis of emotional problems, and the prescribing of selected psychotropic and non-psychotropic drugs. The 32 physicians who completed the study recorded 10,585 patient visits, which accounted for 7934 prescribed drugs. Overall, 549 (6.9%) of the drugs prescribed were classified as psychotropic drugs. After controlling for patient characteristics, there was not a statistically significant relationship between board certification, practice size, or physician age and the rate at which study physicians diagnose emotional problems. Board certification, physician age, physician propensity to prescribe drug therapy, and the feeling that patients expect drug therapy were significantly related to the prescribing of non-psychotropic drugs, the prescribing of psychotropic drugs was not predictable. Only the propensity to prescribe drug therapy was significantly related to the rate at which physicians prescribed drugs for their patients.