ABSTRACT
BACKGROUND: Because patients receiving antipsychotics are at increased risk for coronary heart disease, standards of care for such patients now include periodic glucose and lipid testing. The objective of this study was to examine rates of glucose and lipid monitoring among adult Medicaid patients initiated on antipsychotic therapy. METHODS: California Medicaid (Medi-Cal) claims of 6601 patients identified as "new" antipsychotic users between July 1, 2004 and June 30, 2005 were analyzed. Rates of glucose and lipid testing were compared for 6 months prior to and post-initiation of antipsychotic therapy. Odds ratios (ORs) for testing associated with first-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) use were determined while controlling for patient level factors. RESULTS: In a multivariate analysis, SGA patients were more likely than FGA patients to undergo glucose testing (OR, 1.38; 95% confidence interval [CI], 1.13 to 1.70; P < .01) and lipid testing (OR, 1.43; 95% CI, 1.14 to 1.81; P < .01), respectively. SGA patients were also more likely than FGA patients to receive both glucose and lipid testing in the 6 months following initiation of antipsychotic treatment (OR, 1.40; 95% CI, 1.11 to 1.79, P < .01). CONCLUSION: Although increases in glucose and lipid testing rates were observed among Medi-Cal patients after initiation of antipsychotic therapy, recommended monitoring does not appear to occur universally in this population. Interventions to increase monitoring of these patients are warranted.
Subject(s)
Antipsychotic Agents/blood , Blood Glucose/metabolism , Lipids/blood , Mass Screening/statistics & numerical data , Medicaid/statistics & numerical data , Adult , Biomarkers/blood , Blood Glucose/drug effects , California , Cohort Studies , Comorbidity , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Dyslipidemias/blood , Dyslipidemias/diagnosis , Dyslipidemias/epidemiology , Female , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Psychotic Disorders/blood , Psychotic Disorders/drug therapy , Psychotic Disorders/epidemiology , Sensitivity and Specificity , United States , Young AdultABSTRACT
OBJECTIVES: To create a valid assessment tool to evaluate the readiness of pharmacy students for advanced pharmacy practice experiences (APPEs). DESIGN: The Triple Jump Examination (TJE) was tailored to the 4-year, 2-plus-2 curriculum of the College. It consisted of (1) a written, case-based, closed-book examination, (2) a written, case-based open-book examination, and (3) an objective structured clinical examination (OSCE). The TJE was administered at the end of each 4 academic semesters. Progression of students to APPEs was dependent on achieving a preset minimum cumulative (weighted average) score in the 4 consecutive TJE examinations. ASSESSMENT: The predictive utility of the examination was demonstrated by a strong correlation between the cumulative TJE scores and the preceptor grades in the first year (P3) of APPEs (r = 0.60, p > 0.0001). Reliability of the TJE was shown by strong correlations among the 4 successive TJE examinations. A survey probing the usefulness of TJE indicated acceptance by both students and faculty members. CONCLUSION: The TJE program is an effective tool for the assessment of pharmacy students' readiness for the experiential years. In addition, the TJE provides guidance for students to achieve preparedness for APPE.