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1.
Am J Pharm Educ ; 73(5): 82, 2009 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-19777097

RESUMO

OBJECTIVES: To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability. METHODS: Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes. RESULTS: Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118. CONCLUSIONS: The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources.


Assuntos
Competência Clínica , Educação em Farmácia/organização & administração , Objetivos Organizacionais , Serviço de Farmácia Hospitalar/organização & administração , Preceptoria/organização & administração , Aprendizagem Baseada em Problemas/organização & administração , Faculdades de Farmácia/organização & administração , Estudantes de Farmácia , Acreditação/organização & administração , Alabama , Certificação/organização & administração , Currículo , Georgia , Humanos , Relações Interinstitucionais , Modelos Educacionais , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Fatores de Tempo
2.
Curr Med Res Opin ; 23(6): 1351-65, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17559734

RESUMO

BACKGROUND: Prescribing adjunctive mood stabilizers to manage schizophrenia is prevalent, despite the lack of substantial evidence to support the long-term use of this treatment regimen. OBJECTIVE: The objective of this study was to assess the impact of using adjunctive mood stabilizers on antipsychotic utilization, total health expenditures, inpatient hospitalizations, long-term care stays, and emergency room (ER) visits for patients with schizophrenia. METHODS: Georgia Medicaid claims from 1999 through 2001 were analyzed to identify recipients diagnosed with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 295. XX). The treatment groups consisted of subjects who received combination therapy of mood stabilizers and antipsychotics (including both atypical and typical medications), while the comparison group consisted of subjects who were on antipsychotic medications without exposure to the mood stabilizers under investigation. Four treatment groups (valproate, lithium, carbamazepine, and combination mood stabilizer therapy) were formed based on the mood stabilizers patient received. Differences in annual health care use and expenditures were estimated between propensity score matched treatment and comparison groups controlling for comorbidity, prior utilization, demographic, and health provider specialty. RESULTS: During the 1-year observation period, subjects in treatment groups filled an average of 200-days supply of adjunctive mood stabilizers. These adjunctive mood stabilizer recipients had significantly longer antipsychotic treatment durations than the subjects who did not have exposure to mood stabilizers (valproate + antipsychotic vs. antipsychotic only, net difference: 56.47 days, p < 0.0001; lithium + antipsychotic vs. antipsychotic only, net difference: 90.25 days, p < 0.0001; carbamazepine + antipsychotic vs. antipsychotic only, net difference: 41.27 days, p = 0.0439; multiple mood stabilizers + antipsychotic vs. antipsychotic only, net difference: 83.14 days, p < 0.0001). The intensive pharmacotherapy associated with treatment groups resulted in $900-$1300 higher pharmacy costs than the comparison groups (valproate + antipsychotic vs. antipsychotic only, net difference: $1218.43, p < 0.0001; lithium + antipsychotic vs. antipsychotic only, net difference: $985.79, p = 0.0015; carbamazepine + antipsychotic vs. antipsychotic only, net difference: $911.63, p = 0.0497; multiple mood stabilizers + antipsychotic vs. antipsychotic only, net difference: $1281.91, p < 0.0047). However, there were no statistically significant differences for total health expenditures, hospitalizations, emergency room visits, and nursing home admissions between propensity-matched treatment and control groups. CONCLUSIONS: There were no differences in health care costs or utilization of ER, long-term care, and inpatient services between schizophrenia patients who did and did not receive adjunctive mood stabilizer; however, longer antipsychotic treatment durations were observed in patients receiving adjunctive mood stabilizers. Interpretation of these results is limited by the unknown selection bias between the treatment and the comparison groups and the relatively small number of patients in some treatment groups. The development of a better-controlled study to further evaluate this treatment regimen is warranted.


Assuntos
Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Recursos em Saúde/estatística & dados numéricos , Medicaid , Esquizofrenia/tratamento farmacológico , Adulto , Afeto/efeitos dos fármacos , Algoritmos , Antimaníacos/economia , Antipsicóticos/economia , Carbamazepina/economia , Carbamazepina/uso terapêutico , Quimioterapia Adjuvante , Estudos de Coortes , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Recursos em Saúde/economia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Compostos de Lítio/economia , Compostos de Lítio/uso terapêutico , Assistência de Longa Duração/economia , Assistência de Longa Duração/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Ácido Valproico/economia , Ácido Valproico/uso terapêutico
3.
Am J Pharm Educ ; 70(4): 85, 2006 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-17136204

RESUMO

OBJECTIVES: To develop and validate an instrument that measures professionalism among pharmacy students and recent graduates. METHODS: A pharmacy professionalism survey instrument developed by a focus group was pretested and then administered to all first-year pharmacy students enrolled in the University of Georgia College of Pharmacy and to recent pharmacy graduates who were taking the preparation course for the Georgia Pharmacy Law Examination and North American Pharmacist Licensure Examination. Participants were asked to indicate the extent to which they agreed or disagreed with each of 32 items using a 5-point Likert scale. RESULTS: One hundred thirty first-year pharmacy students and 101 pharmacy graduates participated in the survey. Statistical analysis identified 6 factors (subscales), which were later named excellence, respect for others, altruism, duty, accountability, and honor/integrity, the 6 tenets of professionalism. Item to total correlations ranged from 0.25 to 0.57 on the 6 factors (subscales), and reliability estimates ranged from 0.72 to 0.85 for the 6 factors and total scale. CONCLUSIONS: The Pharmacy Professionalism Instrument measures the 6 tenets of professionalism and exhibits satisfactory reliability measures. Future studies using this scale in other pharmacy populations are needed.


Assuntos
Educação em Farmácia , Avaliação Educacional , Estudantes de Farmácia , Coleta de Dados , Avaliação Educacional/métodos , Feminino , Humanos , Masculino , Competência Profissional , Projetos de Pesquisa
4.
J Clin Psychiatry ; 67(6): 972-82, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16848658

RESUMO

OBJECTIVES: To determine the prevalence of and factors associated with the off-label use of antidepressant, anticonvulsant, and antipsychotic medications. METHOD: A retrospective analysis of Georgia Medicaid recipients was conducted. Recipients prescribed antidepressant, anticonvulsant, or antipsychotic medications were identified. Logistic regression analysis was used to identify factors associated with off-label use. RESULTS: A total of 46,976 (75.42%) antidepressant recipients, 38,497 (80.12%) anticonvulsant recipients, and 21,252 (63.62%) antipsychotic recipients received at least 1 of these medications off-label in 2001. The likelihood of receiving off-label medications increased remarkably with advancing age (>or= 65 vs. < 65 years: antidepressant: OR = 5.15, 95% CI = 4.76 to 5.56; anticonvulsant: OR = 4.54, 95% CI = 4.16 to 4.96; antipsychotic: OR = 5.21, 95% CI = 4.82 to 5.63). Although receiving new anticonvulsants launched after 1993 was the strongest predictor (OR = 7.63, 95% CI = 7.07 to 8.23) of receiving off-label anticonvulsant medications, exposure to newer antidepressants and antipsychotics did not confer a higher chance of receiving off-label medications (selective serotonin reuptake inhibitors vs. tricyclic antidepressants: OR = 0.43, 95% CI = 0.40 to 0.45; atypical vs. conventional antipsychotics: OR = 0.76, 95% CI = 0.72 to 0.80). CONCLUSIONS: The off-label use of antidepressant, anticonvulsant, and antipsychotic medications is highly prevalent. Further research to study the effects of off-label use among this high risk subpopulation may be an important step toward defining the scope of and potential for such use.


Assuntos
Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Medicaid/estatística & dados numéricos , Adolescente , Adulto , Idoso , Rotulagem de Medicamentos , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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