Use of point-of-service health status assessments by community pharmacists to identify and resolve drug-related problems in patients with musculoskeletal disorders.

STUDY OBJECTIVE: To determine whether community pharmacists can use point-of-service health status assessments to identify and resolve drug-related problems (DRPs) in ambulatory patients with selected musculoskeletal (MSK) disorders. DESIGN: Twelve-month, prospective, multicenter demonstration project. SETTING: Twelve independent community pharmacies in eastern Iowa. PATIENTS: Ambulatory patients with self-reported diagnosis of osteoarthritis, rheumatoid arthritis, or low back pain. MEASUREMENTS: During quarterly pharmacy visits for 1 year, patients used touch-screen computers to report their health status. Patients answered questions on the Short Form-36 (SF-36) general health survey, as well as questions assessing limitations associated with their MSK condition. Pharmacists used this data in interviewing patients to assess for DRPs. MAIN RESULTS: The study enrolled 461 patients, of whom 388 returned for the 12-month visit. During this 1-year period, community pharmacists identified 926 cumulative DRPs. Patients with no DRPs had significantly higher physical component summary scores on the SF-36 (p<0.05) than patients with more than one DRP at baseline (36.2 vs 31.6), 6 months (39.2 vs 33.3), and 12 months (40.1 vs 35.4). At 12 months, actions performed by pharmacists led to resolution or improvement of 70.7% of DRPs. CONCLUSION: Drug-related problems are numerous in community-dwelling patients with MSK disorders and correspond to decreased physical health status. Community pharmacists can use patient-reported measures of health status to identify DRPs and initiate processes to resolve them.

Processing prescription drug information under different conditions of presentation.

OBJECTIVES: The purpose of this study was to investigate individuals' processing of prescription drug information under different conditions of presentation. DESIGN: Videotapes and written materials were used to develop 12 different conditions of presentation and data were collected via a mailed survey methodology. Controlling for respondent age, we studied respondents' perceptions of cognitive effort required to process the information, information overload, and evaluative response to the information. Also, we documented and studied the number of questions reported after exposure to the information. SUBJECTS: Study materials were mailed to 624 volunteers living in the United States, of which 477 (76.4%) returned completed data forms. RESULTS AND CONCLUSIONS: The results suggest there is a balance between the need for information at a level sufficient for individuals to make decisions and the need for information that will not overload individuals as they cognitively process it.

Influences on oncologists' adoption of new agents in adjuvant chemotherapy of breast cancer.

PURPOSE: Little is known about how oncologists' adopt new treatments for breast cancer. This study investigated influences on oncologists' adoption of paclitaxel as adjuvant chemotherapy for early-stage breast cancer, 9 months after presentation of phase III data suggesting improved disease-free and overall survival when paclitaxel was added to doxorubicin and cyclophosphamide for such patients. METHODS: Self-reported data were collected with a mail survey of a random sample of 1,200 oncologists practicing in the United States. Using Rogers' model, we measured four types of influences on adoption of innovation: (1) communication channels, (2) innovation characteristics, (3) a practitioner's social system, and (4) physician characteristics. Multiple regression analysis assessed the associations between oncologist adoption of paclitaxel for early-stage breast cancer patients and variables representing the modeled influences on adoption. RESULTS: On average, respondents (n = 181) reported having adopted paclitaxel for 37% of their early-stage breast cancer patients. The overall model was significant, with seven variables associated (P < or = .05) with adoption of paclitaxel. Significant influences on adoption included use of symposia as a therapy information source, physician experience with paclitaxel to treat late-stage breast cancer, and perceived advantage in efficacy of paclitaxel. CONCLUSION: As new modalities become available to treat cancer, it is vital to understand what factors influence oncologists and patients when choosing to use them. Those parties interested in fostering the adoption of new breast cancer treatments should address features of communication channels (eg, use of symposia), characteristics of new treatments (eg, perceived advantage in efficacy), physicians' social systems (eg, patient requests), and characteristics of potential adopters (eg, previous experience with the treatment).

A national survey of U.S. pharmacists in 2000: assessing nonresponse bias of a survey methodology.

The first objective of this study was to assess the existence of nonresponse bias to a national survey of licensed pharmacists conducted in 2000. Three methods were used to assess nonresponse bias. The second objective of the study was to examine reasons why sampled licensed pharmacists did not respond to the national survey of licensed pharmacists. We used data from 2204 respondents to a national survey of pharmacists and from 521 respondents to a survey of nonrespondents to the national survey. We made comparisons between respondents for 5 variables: employment status, gender, age, highest academic degree, and year of initial licensure. Chi-square tests were used to examine differences in the 5 variables between respondents to the first mailing and second mailing of the survey, early and late respondents to the survey, and respondents to the survey and respondents to the nonrespondent survey. There were no significant differences between first mailing and second mailing respondents, but there were differences in each variable except year of licensure between early and late respondents. These differences likely were due to regional bias possibly related to differences in mailing times. There were differences between respondents and nonrespondents in terms of employment status and year of licensure. The main reasons for not responding to the survey were that it was too long or that it was too intrusive. Overall, the survey methodology resulted in a valid sample of licensed pharmacists. Nonresponse bias should be assessed by surveying nonrespondents. Future surveys of pharmacists should consider the length of the survey and the address where it is sent.

An exploratory study of community pharmacy practice change.

OBJECTIVES: (1) To compare the resources and practitioner activities in community pharmacies that have changed practice with those in pharmacies that have not changed; and (2) in pharmacies that have changed practice, to identify factors affecting a pharmacy's ability to support pharmacy practice change. DESIGN: Multiple-case design, in which six pharmacies were studied in depth. SETTING: Six independent community pharmacies in Iowa. PARTICIPANTS: Pharmacy owners. INTERVENTION: A mail survey and an on-site personal interview were used to collect information about the pharmacy's practice changes and influences on the practice change process. MAIN OUTCOME MEASURES: 14 criteria of pharmacy practice change and 5 types of influences on change (environmental variables, organizational variables, owner/manager characteristics, strategy-making features, attributes of change). RESULTS: Three pharmacies had made considerable change, one had made some change, and two had made little or no change. After a broad set of initial changes, subsequent changes tended to be made incrementally. A variety of factors were identified that support pharmacy practice change. Most of the factors were associated with improving resources, such as upgraded staff skills, involvement in demonstration projects, regular environmental scanning, and regular interaction with advocates for pharmacy practice change (e.g., college of pharmacy, pharmacy associations, innovative practitioners). Also, experienced owners who looked to the future and actively addressed constraints were associated with making pharmacy practice change. CONCLUSION: Practitioners and other interested parties should consider a broad array of activities when trying to facilitate pharmacy practice change. Researchers can use these findings to develop studies that will provide stronger scientific evidence that can contribute to a model of pharmacy practice change. The continued study of pharmacy practice change can assist pharmacists working to translate a philosophy of pharmaceutical care into daily practice.

Assessment of patients' perceptions and beliefs regarding herbal therapies.

We evaluated the demographics and beliefs regarding safety and efficacy of herbal therapy among individuals in Iowa and assessed the willingness to discuss the use of these products with health care providers. We distributed 1300 surveys to two random samples: patients attending eight clinics, and residents of the state (mailing). Data were categorized according to herb use and compared between users and nonusers. The response rate was 61% (794 people), with 41.6% of respondents reporting herb use. They were predominately white women and were likely to have had education beyond high school (p<0.05). Their use of prescription drugs was high (p<0.05). Although users rated safety and efficacy of herbs higher than nonusers (p<0.05), both groups believed that health care providers should be aware of use and would provide this information.

The impact of relational activities on HMO organizational outcomes.

OBJECTIVE: To report the findings of an empirical study of health maintenance organization (HMO) organizational outcomes and relational activities in HMO-pharmaceutical manufacturer relations. STUDY DESIGN: A mailed survey of a national random sample of 273 HMOs. SUBJECTS AND METHODS: Data were obtained from 111 HMOs regarding their inter-organizational relations with a pharmaceutical manufacturer. Respondents reported on 3 relational activities (initiating behavior, flexibility, bidirectional communication) and 4 HMO organizational outcomes (long-term orientation, equity in sharing costs and benefits, commitment between partners, financial performance). Also, 3 control variables were assessed: number of enrolled beneficiaries, HMO type, and estimated annual acquisition costs of pharmaceuticals. Four multiple regression analyses were performed, each with one organizational outcome variable as the dependent variable. Measures of relational activities and the control variables were the independent variables in the regressions. RESULTS: The response rate was 40.7%. All 3 relational activities showed significant associations with HMO organizational outcomes. Two relational activities (bidirectional communication, initiating behavior) showed significant and positive associations with a long-term orientation. Independent practice association (IPA)-model HMOs were less likely to report a long-term orientation toward a pharmaceutical manufacturer than other types of HMOs (adjusted R2 = 0.40). Bidirectional communication and flexibility were significantly and positively associated with the equity of costs and benefits (adjusted R2 = 0.29). Commitment had significant positive associations with all 3 relational activities (adjusted R2 = 0.50). All 3 relational activities had significant positive associations with financial performance. HMOs with an annual acquisition cost > $2 million were less likely to report favorable financial performance associated with a pharmaceutical manufacturer than were HMOs with lower costs (adjusted R2 = 0.42). CONCLUSION: Relational activities, such as initiating behavior, flexibility, and bidirectional communication, can facilitate positive outcomes for HMOs. It is important for all parties interested in healthcare to recognize that managing care creates a tension between achieving patient outcomes and organizational outcomes.

Pharmacy service alliances: a tool to reduce uncertainty and create new revenue streams.

OBJECTIVES: (1) Present conceptual support for a type of pharmacy network, a pharmacy service alliance (PSA), (2) describe the development of a PSA in eastern Iowa, and (3) discuss how other types of PSAs can be developed. DESIGN AND PARTICIPANTS: 12 independent pharmacies in eastern Iowa. SETTING: Community pharmacy practice. MAIN OUTCOME MEASURES: Formation of a PSA. RESULTS: Pharmacy members of the Certified Pharmaceutical Care Network, a PSA, have jointly developed new pharmacy services. Collaborative efforts have involved disease state management programs, group marketing activities, and a quality improvement process. CONCLUSION: PSAs offer an organizational model that pharmacies could use to successfully develop new pharmacy services.

Market factors and the availability of community pharmacies.

The purpose of this study was to examine the relationships between the availability of community pharmacies and 4 types of market factors. A composite data set was created that linked, at the county level, data on: (1) type and number of pharmacies; (2) population characteristics; (3) payer variables; (4) health care system factors; and (5) competitive factors. In this exploratory study, secondary data were used to assess the association between the availability of community pharmacies and the influence of market factors. To assess the market influences on availability of community pharmacies, 2 regressions were performed. In 1 model, the number of community pharmacies per 10,000 population was the dependent variable, whereas the dependent variable in the other regression was the proportion of independently owned community pharmacies. The independent variables in each regression were the market factors--population characteristics, payer variables, health care system factors, and competitive variables. Squared terms were included for 8 of 15 market factors to account for nonlinearities in the relationships. Multiple market factors were correlated with both the number of community pharmacies and the proportion of independently owned pharmacies in an area. Several of the relationships were not linear and changed direction within the range of data. Counties with either a low or a high percentage of elderly people had fewer pharmacies and a lower proportion of independently owned pharmacies compared with counties with a moderate percentage of elderly people. Counties that were scarcely or highly rural had fewer community pharmacies but a higher proportion of independently owned pharmacies than counties that were moderately rural. Areas with a greater percentage of the population earning less than the poverty level had more pharmacies, especially independently owned ones. Fewer community pharmacies were found in areas with higher health maintenance organization penetration rates. The number of hospital admissions was positively associated with the number of pharmacies but negatively associated with the proportion of independently owned pharmacies. The availability of community pharmacies varies across the country. In light of the trend toward fewer independently owned pharmacies, potential problems in accessing pharmacy services could develop in certain areas, including those that are highly rural and those with a high percentage of people earning less than the poverty level. Future research and policy issues are identified.

Community pharmacists as patient advocates: physician attitudes.

OBJECTIVES: To assess physician attitudes toward community pharmacists acting as patient advocates with respect to drug-related matters, and to correlate physician attitudes with physician characteristics and physician-pharmacist interactions. SETTING: State of Utah. PARTICIPANTS: Physicians in family practice, internal medicine, pediatrics, and psychiatry. INTERVENTIONS: Mail survey. MAIN OUTCOME MEASURES: Physician attitudes toward community pharmacists performing 15 patients advocacy activities, as well as physician-pharmacist interaction and respondent demographics. RESULTS: Favorable attitudes were identified for pharmacists monitoring drug use, counseling patients, advising physicians, contacting physicians to discuss patients' pharmacotherapy, and recording over-the-counter product use in patient profiles. Attitudes were less favorable toward pharmacists helping patients manage adverse drug reactions, suggesting drug regimen alterations, providing health screening services, selecting drugs by a protocol, discussing therapeutic equivalents with patients, and changing dosage forms to better suit patient needs. Physician age was negatively correlated with attitude toward a pharmacist aiding a physician in selecting a drug to be prescribed. The helpfulness of physician-pharmacist interactions was positively correlated with physician attitudes. CONCLUSION: From the physician's perspective, the most appropriate areas for expansion of the community pharmacist's role into patient advocacy are in monitoring pharmacotherapy, assisting physicians in coordinating pharmacotherapy, and providing patients with medication information. Physician resistance is more likely in areas where community pharmacists assume a more autonomous role in patient care.

Rote learning after exposure to a direct-to-consumer television advertisement for a prescription drug.

The purpose of this exploratory study was to: (1) test the rote learning response; and (2) investigate the effects of selected consumer demographic/psychographic, information-access, and health-related knowledge/experience variables on rote learning after exposure to a televised direct-to-consumer prescription drug advertisement that was developed and broadcast under new US Food and Drug Administration guidelines. A judgment (nonprobability) sample of 202 individuals waiting for their appointments at a university-based general medicine clinic was selected to view a televised advertisement and complete a questionnaire. One participant returned an unusable form; 24 others held positions in health care occupations and were omitted from the analysis. Results based on responses from the 177 eligible participants showed that the presentation of both promotional and risk-related product information in the same broadcast advertisement may lead to viewer problems with rote learning of each type of information.

Cooperation in pharmacy-drug wholesaler relations.

OBJECTIVE: The objective of this study was to investigate the associations between characteristics of pharmacy-wholesaler relations and cooperation in those relations. DESIGN/SAMPLE: Data were obtained from 326 pharmacies about 214 pharmacy-primary wholesaler relations and 112 pharmacy-secondary wholesaler relations. MEASURES: Separate multiple regressions were performed to test the hypotheses for both types of pharmacy-wholesaler relationship. For each regression, cooperation was the dependent variable, while the independent variables were customer service level, trust, pharmacy influence, wholesaler influence, and duration of relations. RESULTS: For primary wholesalers (adjusted R-square = 0.59), three variables had significant associations with cooperation: trust, pharmacy influence, and customer service level. Conversely, the model for secondary wholesalers (adjusted R-square = 0.60) showed that only trust and pharmacy influence were significantly related to cooperation. CONCLUSIONS: Trust and perceived pharmacy influence are important to all wholesalers in fostering and maintaining cooperation from their customers. In addition, level of customer service is an important variable for primary wholesalers working to develop cooperation with their customers.

The political economy of pharmaceutical marketing channels: a conceptual framework.

The political economy framework is presented as a guide to investigate pharmaceutical marketing channels. Based on the framework, pharmaceutical marketing channels are conceptualized as four interacting areas: the environment, the economy, the policy, and the performance of the channel. Examples of this approach are illustrated. The usefulness of the framework for future research and management of pharmaceutical marketing channels is discussed, and strengths and weaknesses are identified.

Measuring product meaning for prescribed medication using a means-end chain model.

On the basis of a means-end chain model, the product attribute and consequence levels of consumers' product meaning for prescribed medication were measured for a sample of 550 consumers. Using exploratory factor analysis on a 30-item scale, the authors identified five product attribute dimensions and three consequence dimensions. The means-end chain model can help marketers of health care learn more about how consumers categorize product meanings, which in turn can be used in the development of marketing strategies.