Cost of providing pharmaceutical services to hospice patients.

The cost to a hospital pharmacy department of providing pharmaceutical services for a hospice program was studied. Drug acquisition costs were tabulated for all prescriptions dispensed to patients in the hospice program from April 1, 1992, to March 31, 1993. Direct time studies were conducted to determine the average personnel time involved in dispensing a prescription for a hospice patient. To determine the personnel time associated with auxiliary activities, self-reporting and work-sampling techniques were used. Indirect and delivery costs were also calculated. Relevant resource inputs were identified, measured, and valued by using both observation and pharmacy records. A total of 5640 hospice prescriptions were dispensed by the outpatient pharmacy; these represented 30% of all prescriptions dispensed. The average cost of dispensing a hospice prescription was $14.91 (total annual costs less drug acquisition costs). The total annual cost of providing pharmaceutical services to the hospice's patients was $196,607, and the total annual reimbursement received from the hospice program and self-paying patients was $155,623; therefore, costs exceeded revenues by $40,984. The cost to a pharmacy department of providing pharmaceutical services to patients in a hospice program substantially exceeded revenues. Greater efficiencies, a change in the pricing structure, or both may be necessary.

Points to consider about prescription drug prices: an overview of federal policy and pricing studies.

Pharmaceutical prices in the United States are under evaluation as policy makers decide how to reduce health care expenditures and public subsidy of the pharmaceutical industry. Furthermore, evidence of higher drug prices in the United States, compared with those in other countries, fuels the prescription drug price debate. These issues are not new to the public forum and much can be learned from prior debates and policies. This paper begins by reviewing the pricing debate with the Kefauver hearings on monopolies held during the late 1950s and early 1960s and continues with the current price debate. Government reports and academic studies are discussed, addressing the methodological differences and their implications to policy makers. Finally, the literature review includes foreign government prescription drug programs with their respective prescription drug expenditures. Evidence provided by academics about the pricing practices of the drug manufacturers indicates product quality and price information would force firms to compete on the price level, thus reducing pharmaceutical product pricing to the "true" market price.

Attention, distraction, and cold-pressor pain.

This article compares the effects of distracting oneself from, versus attending to, the sensations produced by cold-pressor stimulation. Experiment 1 revealed that distraction is a better coping strategy than attention to sensations when subjects are asked to report pain threshold and tolerance. Experiments 2 and 3 examined the hypothesis that distraction is effective because persons hold a commonsense belief in the benefits of distraction as a coping device. Neither experiment supported the commonsense hypothesis as an explanation for the findings of Experiment 1. In a final experiment, subjects were assigned to either a distraction, attention, or no-instructions condition and were asked to report their distress during a 4-minute cold-pressor trial. Distraction reduced distress early in the trial, but attention to sensations proved to be a superior strategy for the last 2 minutes of the trial. It is proposed that distraction and attention to sensations may be differentially effective depending on the duration of the painful stimulus. Possible mediating processes underlying the two strategies are discussed.