Effects of a 3-Tier Pharmacy Benefit Design on the Prescription Purchasing Behavior of Individuals With Chronic Disease.

OBJECTIVE: To evaluate the impact of 3-tier (copayment) pharmacy benefit structures on medication utilization behavior. METHODS: A pretest-posttest quasi-experimental design was employed. Chronic disease sufferers (N=8,132) from a health plan were classified into the following groups: (a) 2-tier copayment moving to a 3-tier structure, ("converting" group), (b) 2-tier staying in a 2-tier structure and, (c) 3-tier staying in a 3-tier structure. The latter 2 were "comparison" groups. Two 7-month time periods were determined: the "preperiod" (June through December 2000) and the "postperiod" (January through July 2001) for a change in pharmacy benefit structure. Pharmacy claims data were used for data collection. Statistical analyses included bivariate tests to evaluate predifferences and postdifferences across study groups. Maximum likelihood estimates from a repeated measures model were used to examine changes in formulary compliance and generic use rates. Discontinuation of nonformulary medications was evaluated using logistic regression. RESULTS: Controlling for demographics, number of comorbidities, disease state, and pharmacy benefit structure, the formulary compliance rate increased by 5.6% for the converting group. No significant increases were seen for the comparison groups. Generic use rates increased by 6 to 8 absolute percentage points for all groups (3.3% to 4.9 % adjusted rates). Converting group members were 1.76 times more likely to discontinue their nonformulary medication than those in the 2-tier comparison group and 1.49 times more likely than those in the 3-tier comparison group. CONCLUSIONS: These findings suggest that shifting individuals from a 2-tier to a 3-tier drug benefit copayment structure resulted in changes in medication utilization. Decision makers need to balance these changes with the potential dissatisfaction that members may express in paying higher copayments. DISCLOSURES: Funding for this research was provided by Merck and Company through the Academic Medicine and Managed Care Forum and was obtained by authors Kavita V. Nair, Robert J. Valuck, Pamela Wolfe, Julie M. Ganther, and Marianne M. McCollum. Nair served as principal author of the study. Study concept and design was contributed by Nair, Valuck, Wolfe, Ganther, McCollum, and author Sonya J. Lewis. Analysis and interpretation of data and drafting of the manuscript were primarily the work of Nair and Wolfe, and all authors contributed to the critical revision of the manuscript. Statistical expertise was contributed by Wolfe. Administrative, technical, and/or material support was provided by Mark Enders.

Team-Based Learning for Immunology Courses in Allied Health Programs.

Immunology is now a major component of studies in human biology, with many diseases having immune system involvement. Because so many areas of study include aspects of immunological knowledge, how to teach and incorporate immunology must be evaluated and assessed at all levels of education including K-12, undergraduate, graduate, medical, and professional programs. Traditional teaching methods such as lecture have significant shortcomings which make them less appealing to students today who are more digitally inclined and demand more active and engaging learning environments. Herein, we describe and propose the use of the active learning model of Team-Based Learning (TBL) to incorporate immunology into medical and professional programs. TBL is defined as an evidence based collaborative learning strategy taught in a three-step cycle: pre-class preparation, in-class readiness assurance testing (RAT), and application-focused exercises. In TBL, students are assigned to 6-7 member teams. Students complete the in-class RAT individually followed by taking the RAT as a team (T-RAT). Following the RAT and T-RAT, the instructor can then provide immediate feedback on concepts that proved especially difficult. The remainder of class time is then spent with teams working case studies and applications relative to the instructional topic or disease. Teams decide the best outcome or answer for a given application and report their answers simultaneously in class, followed by a discussion facilitated by the instructor. Research indicates that students involved in active learning classes, such as those using TBL have significantly increased levels of student engagement and high performance on examinations. This review will highlight how to implement TBL into a professional program (medical, dental, nursing, or pharmacy), how to assess student performance and provide real world examples of case studies and applications.

Characterization of Use of the Pharmacy Curriculum Outcomes Assessment Across Accredited Colleges of Pharmacy.

Objective. To characterize use of the Pharmacy Curriculum Outcomes Assessment (PCOA) in terms of timing, manner of delivery, and application of the results by accredited colleges of pharmacy. Methods. Accredited pharmacy programs were surveyed regarding PCOA administration, perceived benefits, and practical application of score reports. Survey items were comprised of new items developed from a literature review and items from prior studies. The survey addressed five domains: program demographics, administration, student preparation, use of results, and recommendations to improve the utility of the PCOA. Results. Responses were received from 126 of 139 (91%) surveyed programs. The majority of respondent programs administered PCOA in one session on a single campus. Most indicated PCOA results had limited use for individual student assessment. Almost half reported that results were or could be useful in curriculum review and benchmarking. Considerable variability existed in the preparation and incentives for PCOA performance. Differences in some results were found based on prior PCOA experience and between new vs older programs. Open-ended responses provided suggestions to enhance the application and utility of PCOA. Conclusion. The intended uses of PCOA results, such as for student assessment, curricular review, and programmatic benchmarking, are not being implemented across the academy. Streamlining examination logistics, providing additional examination-related data, and clarifying the purpose of the examination to faculty members and students may increase the utility of PCOA results.

Peer Evaluation Instrument Development, Administration, and Assessment in a Team-based Learning Curriculum.

Objective. To design and implement an instrument capable of providing students with valuable peer feedback on team behaviors and to provide results of the administration of the instrument. Methods. A three-part instrument was designed that requires teammate rankings with justification on attributes aligned with school outcomes and team functioning, reporting of student behaviors, and provision of feedback on the value of peer contributions to their team. Score results after three years of administration were analyzed. Results. Six evaluations per year were completed by members of four different professional classes over a three-year time period. Mean scores increased slightly as students progressed through the program. Students were able to differentially score peers on attributes and behaviors. Conclusion. The peer evaluation instrument presented here provides formative and summative feedback through qualitative and quantitative scores that allow students to acknowledge differential contributions of individual team members.

A correlation study of social network usage among health care students.

BACKGROUND: Due to anecdotal concerns about adequacy of health professions students' communication skills, health professions faculty at a private university formed an interprofessional research team. The study was designed to explore whether the use of social networking services (SNS) influenced health care students' written and oral communication skills. METHOD: One hundred thirty-two students participated in the study. Communication skills were assessed by using assignments from a health care ethics course required of all students. Use of SNS was measured with an information technology questionnaire. RESULTS: Contrary to expected findings, this exploratory correlation study found no meaningful relationship between the frequency of SNS usage and oral and written communication skills in health professions students. CONCLUSIONS: Future studies of SNS would benefit from a younger and more homogeneous study population to assess the use of SNS for learning versus leisure.

Team-based learning in US colleges and schools of pharmacy.

OBJECTIVE: To characterize the use of team-based learning (TBL) in US colleges and schools of pharmacy, including factors that may affect implementation and perceptions of faculty members regarding the impact of TBL on educational outcomes. METHODS: Respondents identified factors that inhibit or enable TBL use and its impact on student learning. Results were stratified by type of institution (public/private), class size, and TBL experience. RESULTS: Sixty-nine of 100 faculty members (69%) representing 43 (86%) institutions responded. Major factors considered to enable TBL implementation included a single campus and student and administration buy-in. Inhibiting factors included distant campuses, faculty resistance, and lack of training. Compared with traditional lectures, TBL is perceived to enhance student engagement, improve students' preparation for class, and promote achievement of course outcomes. In addition, TBL is perceived to be more effective than lectures at fostering learning in all 6 domains of Bloom's Taxonomy. CONCLUSIONS: Despite potential implementation challenges, faculty members perceive that TBL improves student engagement and learning.

Further development of pharmacy student-facilitated diabetes management clinics.

OBJECTIVE: To further develop and evaluate a diabetes disease state management (DSM) program that provided direct patient care responsibilities to advanced pharmacy practice experience (APPE) students as members of healthcare teams. DESIGN: Nine new clinics and 3 established sites that provide self-care management education to patients with diabetes were established and maintained in rural Colorado pharmacies and supported by students in APPE training for 48 weeks per year. EVALUATION: The 12 clinics provided 120 APPE student placements in 2010-2011. Students' perceptions of their experiences were positive. Patients who completed the student-supported diabetes self-management education program had improvements in blood glucose, blood pressure, and lipid values. CONCLUSIONS: Twelve diabetes DSM clinics provided direct patient care opportunities to APPE students working as part of healthcare teams while expanding healthcare resources in underserved communities in Colorado.

Physician acceptance of pharmacotherapy recommendations made by pharmacy students in a rural pharmacy-based diabetes care and education clinic.

OBJECTIVE: To assess outcomes from a rural, community pharmacy-based diabetes care and education program involving collaboration between local pharmacists and physicians, fourth-year pharmacy students, and University of Colorado Denver School of Pharmacy faculty members. DESIGN: Fourth-year pharmacy students provided education and testing (hemoglobin A1c, blood glucose, blood pressure, and lipid profiles) to diabetes patients, once a month for 6 months. Clinical notes with medication recommendations were faxed to each patient's physician following each visit. ASSESSMENT: Twelve pharmacy students made 533 recommendations to 29 physicians for 52 patients over 18 months. Overall, 32% of the recommendations were accepted based on subsequent medication orders and patient reports. Three of the physicians accepted 50%-60% of the recommendations they received while 4 did not accept any recommendations. CONCLUSIONS: Physician acceptance of pharmacy students' medication recommendations for patients attending a rural community pharmacy-based diabetes management clinic varied. Further study is needed to determine the reasons for this.

Inconsistent health perceptions for US women and men with diabetes.

BACKGROUND: Two health status measures for adults with diabetes are compared in order to identify gender-based differences between norm-based scores for health status and self-rated health scores. METHODS: Data were obtained from the 2001 and 2003 Medical Expenditure Panel Survey(MEPS). Diabetes was identified by self-report or ICD-9 code. Demographic and clinical (e.g., body mass index [BMI], comorbidities) parameters were included. Outcomes were norm-based measures of physical and mental health (SF-12 Physical and Mental Component Scores: SF-12 PCS and SF-12 MCS) and self-rated perception of health status. Sex-based differences in the three outcome measures, SF-12 PCS, SF-12 MCS, and self-rated health scores, were evaluated in univariate analyses and multivariate linear regression for survey data. RESULTS: A cohort of 3640 respondents with diabetes was identified (2037 women, 1603 men). In unadjusted analyses, women were older than men (60.7 vs. 59.3 years, p<0.001), reported higher mean BMI (31.1 vs. 30.4), more comorbidities, depression, and physical limitations (all p<0.001), had poorer SF-12 MCS scores (p=0.01), and self-rated their health status significantly higher than did men (p<0.01). In adjusted analyses, female gender was associated with lower SF-12 MCS scores and higher self-rated health scores. No factors were positively associated with higher scores across all three measures; only cognitive limitations consistently predicted lower health status scores in all three measures. CONCLUSIONS: Among adults with diabetes in a nationally representative sample of the U.S. adult population, discrepancies exist in health status measures. Despite being older, having more comorbidities and physical limitations, and lower norm-based scores for mental functional status, women self-rate their own health status higher than do men. Further research into the gender-based determinants and clinical implications of self-rated health status is warranted.

Evaluation of an evidence-based peer teaching assessment program.

OBJECTIVE: To determine faculty perceptions about an evidence-based peer teaching assessment system. METHODS: Faculty members who served as instructors and assessors completed questionnaires after year 1 (2002-2003) and year 4 (2005-2006) of the peer assessment program. Factors were evaluated using a Likert scale (1 = strongly disagree; 5 = strongly agree) and included logistics, time, fostering quality teaching, diversifying teaching portfolios, faculty mentoring, and value of structured discussion of teaching among faculty members. Mean responses from instructors and assessors were compared using student t tests. RESULTS: Twenty-seven assessors and 52 instructors completed survey instruments. Assessors and instructors had positive perceptions of the process as indicated by the following mean (SD) scores: logistics = 4.0 (1.0), time = 3.6 (1.1), quality teaching = 4.0 (0.9), diversifying teaching portfolios = 3.6 (1.2), faculty mentoring = 3.9 (0.9), and structured discussion of teaching = 4.2 (0.8). Assessors agreed more strongly than instructors that the feedback provided would improve the quality of lecturing (4.5 vs. 3.9, p < 0.01) and course materials (4.3 vs. 3.6, p < 0.01). CONCLUSION: This peer assessment process was well-accepted and provided a positive experience for the participants. Faculty members perceived that the quality of their teaching would improve and enjoyed the opportunity to have structured discussions about teaching.

A comparison of costs and hospital length of stay associated with intravenous/oral linezolid or intravenous vancomycin treatment of complicated skin and soft-tissue infections caused by suspected or confirmed methicillin-resistant Staphylococcus aureus in elderly US patients.

OBJECTIVES: This study compared the costs and hospital length of stay (LOS) and duration of intravenous therapy associated with intravenous/oral linezolid or intravenous vancomycin treatment of complicated skin and soft-tissue infections (cSSTIs) caused by suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA) in elderly US patients. METHODS: Data were obtained from elderly (>or=65 years) US patients participating in a multinational randomized trial of hospitalized cSSTI patients treated with linezolid or vancomycin. Costs (hospital and total) from the provider perspective were estimated for intent-to-treat (ITT) patients (ie, all those receiving >or=1 dose) using national 2003 costs (ward, medication, intravenous administration). LOS for inpatient care, duration of intravenous linezolid and vancomycin therapy (ITT and MRSA groups), and cure rates were evaluated. RESULTS: Of 717 enrolled subjects, 163 (23%) were elderly (87 linezolid, 76 vancomycin), with no significant differences in demographic characteristics between the linezolid and vancomycin groups. Mean hospitalization and total costs were lower with linezolid compared with vancomycin (hospitalization: US $4510 vs US $6478, P<0.001; total: US $6009 vs US $7329, P=0.03). Linezolid was associated with a 3.5-day reduction in LOS and a 9.5-day reduction in the duration of intravenous therapy compared with vancomycin in the ITT group (both, P<0.001). Cure rates were comparable between linezolid and vancomycin in both the ITT group (88.7% vs 81.4%, respectively) and the MRSA group (80.0% vs 71.4%). In multivariate analyses of the ITT group, linezolid patients were 57% less likely than vancomycin patients to have a LOS >7 days (odds ratio = 0.43; 95% CI, 0.21-0.87). Chronic renal failure, malnutrition, and a diagnosis of infected ulcer predicted an LOS >7 days. CONCLUSIONS: In this analysis of data from elderly patients with cSSTI caused by suspected or confirmed MRSA, linezolid treatment was associated with reductions in the costs of care, LOS, and duration of intravenous treatment without affecting the clinical outcomes. Although the use of a subset of patients from a larger trial that did not focus on the elderly can be seen as a study limitation, the elderly represent an important population when evaluating health care resource use and costs.

Diabetes, minor depression and health care utilization and expenditures: a retrospective database study.

BACKGROUND: To estimate the prevalence of minor depression among US adults with diabetes, health care resource utilization, and expenditures by people with diabetes with and without minor depression. METHODS: Among adult 2003 Medical Expenditure Panel Survey respondents, diabetes was identified by diagnosis code and self-report. Depression was identified by diagnosis code plus > or = one antidepressant prescription. Odds of having depression was estimated in people with diabetes and the general population, adjusted for sociodemographic variables (e.g., age, sex, race/ethnicity). Multivariate regressions evaluated factors associated with utilization and log-transformed expenditures for ambulatory care, hospitalizations, emergency visits, and prescriptions. RESULTS: In 2003, 1932 respondents had diabetes, 435/1932 had diabetes and minor depression. Adults with diabetes were more likely than the general population to have depression (adjusted OR 1.81, 95% CI 1.56, 2.09). People with diabetes with versus without comorbid depression were more likely to be women, have lower incomes and health status, and more diabetes complications (all p < 0.05). In unadjusted analyses, ambulatory care visits were higher for those with versus without depression (17.9 vs. 11.4, p = 0.04), as were prescriptions (60.7 vs. 38.1, p = 0.05). In adjusted analyses, depression was not associated with increased resource use or higher expenditures in any category. Increased number of comorbid conditions was associated with increased resource use in all categories, and increased expenditures for ambulatory care and prescriptions. CONCLUSION: People with diabetes are twice as likely to have depression as the general population. Screening for and treatment of depression is warranted, as is additional research into a causal relationship between diabetes and depression.

Race, ethnicity, and use of thiazolidinediones among US adults with diabetes.

OBJECTIVE: Significant race and ethnic disparities exist in diabetes-related health care. Using a nationally representative database, we sought to determine if use of thiazolidinediones (TZDs) differs by race and ethnicity. As a secondary objective, we sought to determine if race and ethnicity is associated with use of older oral antidiabetic agents, such as sulfonylureas and metformin. RESEARCH DESIGN AND METHODS: Adult respondents to the 2003 Medical Expenditure Panel Survey with diabetes, identified by diagnosis code or self-report, were included. Race/ethnic groups were defined as: White/not-Hispanic; Black/not-Hispanic; Hispanic; or Other/not-Hispanic. Associations between use of oral antidiabetic agents (defined as > or = 1 prescription for a TZD, sulfonylurea, or metformin) and race/ethnicity, sex, age, insurance status, poverty status, and having a usual source of care were evaluated in univariate analyses with chi(2) tests and in adjusted analyses using logistic regression methods for survey data. RESULTS: A total of 1873 US adults with diabetes were identified, with use of oral antidiabetic agents varying by drug class: 23.1% received TZDs, 45.3% received metformin, and 43.8% received sulfonylureas. Use of oral antidiabetic agents, by drug class, did not differ significantly by race/ethnicity (p = 0.33 for TZDs, p = 0.43 for metformin, p = 0.38 for sulfonylureas). In univariate analyses, only insurance status was significantly associated with use of TZDs (p = 0.03), and no variables were associated with use of sulfonylureas or metformin. In adjusted logistic regression analyses, there were no significant predictors of the use of TZDs or metformin, and only age was significantly associated with the use of sulfonylureas. CONCLUSIONS: In a nationally representative database, fewer US adults with diabetes received TZDs compared with sulfonylureas or metformin in 2003. Although we were not able to differentiate between type 1 and type 2 diabetes, nor did we assess oral agent monotherapy versus combination therapy, we found that use of TZDs, sulfonylureas, and metformin did not differ based on race/ethnicity or other demographic variables such as sex, insurance status, poverty status, or having a usual source of health care.

Minor depression and health status among US adults with diabetes mellitus.

OBJECTIVE: To determine whether diabetes mellitus (DM) with minor depression is associated with poorer levels of mental and physical functioning compared with DM without depression. STUDY DESIGN: Retrospective database study. METHODS: US adults participating in the 2001 Medical Expenditure Panel Survey were included in these analyses. Main outcome measures were differences in health status, physical and cognitive limitations, and the Short-Form 12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS) for US adults with DM stratified by minor depression status and evaluated using univariate and multivariate analyses to control for demographic, behavioral, and clinical covariates. RESULTS: A total of 1572 respondents with DM were included (1443 without depression, 129 with depression). Compared with people with DM and without depression, those with DM and minor depression were younger (P = .04); were more likely to be female, white, and smokers; and to have physical and cognitive limitations and lower SF-12 MCS and PCS scores (all P < .01). In multivariate analyses, minor depression was independently associated with lower self-reported health status, MCS scores, and more cognitive limitations. CONCLUSION: People with DM and minor depression have lower mental functional scores, more cognitive limitations, and lower self-reported health status scores compared with people with DM and without depression, differences that may adversely affect self-care activities. Primary and DM care providers should screen for and be aware of depression in their patients with DM.

Discrepancies in identification of bleeding events after percutaneous coronary intervention.

STUDY OBJECTIVE: To evaluate the level of agreement between two sets of criteria, the Thrombolysis in Myocardial Infarction (TIMI) criteria and investigator-developed criteria, for identifying bleeding events in patients who had undergone a percutaneous coronary intervention (PCI) and to measure length of hospital stay (LOS) as a surrogate marker of bleeding severity. DESIGN: Retrospective chart review. SETTING: Two university-affiliated medical centers. PATIENTS: Four hundred twenty-two consecutive patients who had undergone PCI from December 1, 2001-June 30, 2002. MEASUREMENTS AND MAIN RESULTS: Data were collected on the number of bleeding events that occurred within 1 week after PCI (limited to one event/patient) and on LOS. Bleeding was assessed by TIMI criteria and by investigator-developed criteria. Bleeding according to TIMI criteria included intracranial hemorrhage, spontaneous hematuria or hematemesis, or decreases in hemoglobin level. Bleeding according to investigator-developed criteria included intracranial, retroperitoneal, intraocular, or clinically overt bleeding without a specified decrease in hemoglobin level. Agreement between criteria was assessed by means of the kappa statistic. Of the 422 patients, 23 (5%) experienced TIMI-defined bleeding events and 229 (54%) investigator-defined bleeding events. A kappa value of 0.09 (95% confidence interval 0.06-0.13) indicated a poor level of agreement between the two sets of bleeding criteria. The effect of this discrepancy on LOS was 66 fewer days of care when TIMI criteria were applied versus investigator-developed criteria in the 206 patients who experienced bleeding events that met investigator criteria (total LOS 645 days) but not TIMI criteria (total LOS 579 days). CONCLUSION: Bleeding assessment with use of TIMI criteria versus investigator-developed criteria yielded discrepant bleeding event rates and LOS, making it difficult to accurately compare bleeding rates and consequences across clinical trials and in practice. Consensus bleeding criteria are needed for applications in clinical evaluations of antithrombotic agents.

Prevalence of multiple cardiac risk factors in US adults with diabetes.

PURPOSE: The National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) included diabetes mellitus (DM) as a risk factor for major coronary events equivalent to existing coronary heart disease (CHD). This study estimates the national prevalence of additional CHD risk factors for US adults with and without DM and heart disease using Medical Expenditure Panel Survey (MEPS) data. METHODS: In this retrospective study using nationally representative 2000 and 2002 MEPS survey data, DM and CHD for adult respondents (n = 44 481) were identified by ICD-9 codes or self-reported DM, coronary heart disease, angina, heart attack or stroke, or other heart disease. Six additional risk factors assessed were hypertension, hypercholesterolemia, smoking, age (> or = 45 years [men], > or = 55 years [women]), obesity, and physical inactivity. The national prevalence of cardiac risk factors was assessed in four subgroups: CHD-/DM-; CHD-/DM+; CHD+/DM-, CHD+/DM+. RESULTS: The CHD-/DM+ group had significantly higher mean risk factor counts than did the CHD-/DM- group and the CHD+/DM- group (2.6 versus 1.4 and 2.4, respectively; both p < 0.01). The CHD+/DM+ group had the highest mean risk factor count at 3.4. Proportions of US adults in each subgroup with two or more risk factors were CHD-/DM-: 39.5%; CHD-/DM+: 81.9%; CHD+/DM-: 74.9%; CHD+/DM+: 95.1%. Limitations of this study include the use of self-reported data and the lack of data regarding family history of CHD, both of which are likely to result in conservative prevalence estimates. CONCLUSION: Results presented here indicate that diabetes, with or without co-morbid heart disease, is associated with a high prevalence of cardiac risk factors in US adults. The prevalence estimates reported here demonstrate the extensiveness of this public health issue. It is essential that medical providers treat modifiable risk factors in patients with diabetes aggressively with lifestyle modifications and pharmacotherapy consistent with NCEP ATP III recommendations.

Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety.

OBJECTIVES: Evaluate potassium and phosphorus repletion in hospitalized patients. Assess the potential role for use of various methods, including healthcare information technology, to improve prescribing and patient safety. RESEARCH DESIGN AND METHODS: Inpatient medication profiles were screened to identify orders for potassium and phosphorus replacement products. Electronic laboratory and medical records were used to evaluate efficacy and safety. Eligibility for oral therapy was defined by the presence of other scheduled oral medications on the medication profile. Appropriateness of prescribing was based on adherence to the hospital guidelines for repletion. RESULTS: Overall, 134 orders for potassium in 92 patients and 36 orders for phosphorus in 27 patients were evaluated over a 3-week data collection period. Intravenous (IV) potassium was prescribed in 73% of replacement episodes (46% as single doses and 54% within large volume IV fluids), with 85% for normokalemia or mild-to-moderate cases of hypokalemia. Phosphorus orders involved single doses of IV potassium phosphate (mean 13.1 mmol) in 75% of cases. Approximately 85% of doses were for mild or moderate hypophosphatemia. Eligibility for oral therapy was evident in 74% of normokalemic or mild hypokalemic cases receiving IV potassium products and in 33% of cases receiving IV phosphorus replacement. Six cases of mild hyperkalemia were observed. No hyperphosphatemia was documented. Study limitations include use of a retrospective design, inability to discern whether some electrolyte doses were given with a preventative intent, potential overestimation of the number of patients eligible for oral repletion, and lack of data on the accessibility of the laboratory serum concentrations or the awareness of serum values to the prescribers. CONCLUSIONS: Intravenous potassium and phosphate products are commonly prescribed for mild or moderate cases of hypokalemia or hypophosphatemia. Many patients met eligibility for oral therapy. Efforts to enhance prescriber education and implement computerized prescribing and decision support systems have the potential to improve prescribing and reduce possibilities of adverse drug events and medication errors related to potassium and phosphate administration.

Gender differences in diabetes mellitus and effects on self-care activity.

BACKGROUND: Effective self-care, including adherence to diet, exercise, and medication regimens, is an essential component of health care for individuals with diabetes mellitus (DM). OBJECTIVE: The goals of this study were to examine sex-based differences in DM and to explore the effects of gender on self-care. METHODS: This study was conducted retrospectively using data from the 2001 Medical Expenditure Panel Survey (MEPS). People with DM were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code; analyses were stratified by sex. Variables included age, race/ethnicity, education, income, body mass index (BMI), number of comorbidities, physical and cognitive limitations, smoking status, and depression. Outcome measures were assessed by Short Form-12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS) scores. Univariate analyses were determined using t, chi(2), or Fisher exact tests, as appropriate. Multivariate analyses examined associations between sex and SF-12 MCS/PCS scores adjusted for other variables. RESULTS: A total of 1653 MEPS respondents (883 women, 770 men) with DM were identified for the current study. The women were significantly older than the men (61.2 vs 59.1 years), had less education (11.1 vs 12.0 years), and had lower incomes. Women had higher calculated BMI (31.4 vs 30.3), more comorbidities (7.8 vs 6.4), more depression, and more physical and cognitive limitations than did men. Women also scored lower than men on the SF-12 MCS and PCS (47.8 vs 49.9 and 38.2 vs 41.4, respectively). All these measures were statistically significant (P < 0.01). In multivariate analyses, physical limitations, BMI, and number of comorbidities were negatively correlated, and income and education were positively correlated, with MCS and PCS scores. CONCLUSIONS: Compared with their male counterparts, diabetic women scored lower on measures of health status and functioning-factors that are likely to affect self-care activities. Sex-based differences should be considered when developing screening and treatment programs for people with DM.