Albert I. Wertheimer

Using the health belief model to predict initial drug therapy defaulting

In a study of HMO patients, a Health Belief Model (HBM) questionnaire was tested to determine whether initially drug defaulting patients could be differentiated from initially compliant patients. The results of discriminant analysis indicated that individuals in the two groups could be correctly classified at a level of 68.7%. The variables on which the initially defaulting sample collectively scored less on, and which produced the most discrimination between the two groups, were: feedback from physicians on how to take a newly prescribed drug: belief in benefits of medical care for symptoms or illnesses; convenience factors including travel, need for day care and time off from work without pay needed for medical services; length of HMO membership; and education. A total of 20% of the variance in the derived discriminant function could be accounted for by the two groups. The results indicate the utility of the HBM as a tool of prediction for this form of noncompliance, and suggest possible other patient behaviors that may be able to be predicted by the model. The results further suggest the need for increased communication between providers and patients in the health care setting.

Sources of information and influence on new drug prescribing among physicians in an HMO.

Abstract Twenty-nine full-time pediatric and adult medicine practitioners in a health maintenance organization (HMO) were interviewed and prescribing patterns monitored to assess the sources of drug information used, and the patterns of communication and influence affecting decisions to prescribe two new drugs. Findings indicated that physicians used primarily literature-based sources for general drug information. The source of first news concerning the drug was found to differ according to the drug involved. However, the source most influential in encouraging first prescribing of the new drug in each case was reported to be colleagues. The role of colleagues in the prescribing process was further investigated by examining the sociometric location of physician in professional consultantship and social friendship interaction networks. The networks were found to be similar; physicians most often consulted on matters of drug therapy also tended to be most frequently named as social friends. The most highly integrated physicians also tended to be the most highly involved in medical activities outside of practice. None of these attributes, however, were associated with time of adoption of either target drug. These findings fail to confirm those of earlier investigators, and suggest that the function of colleagues as influentials in the decision to initially prescribe new drugs is not consistent among time periods or practice settings, and cannot consistently be predicted.

Pharmacy and the U.S. health care system

Contents Chapter 1: Introduction: Impacts Upon Pharmacy Medication Use and Acquisition Conclusion Chapter 2: Overview of Health Care in the United States Health and Disease Historical Evolution of Health Services The Private Heath Care Sector The Public Health Care System Health Care: Right or Privilege Conclusion Chapter 3: Financing Health Care in the United States Intro- duction and Purpose History and Organizations Summary Chapter 4: Cost and Utilization Controls Cost-Sharing Strategies Capitation Utilization Controls Product Cost Controls Conclusion Chapter 5: Managed Care What Is Managed Care Costs, Prices, and Spending Three Generations of Managed Care How MCOs Reduce Costs Capitation and the Practice of Medicine Managing Health Care Services and Resources Fundamental Organization Structures in Managed Care Health Benefits Financing and Provider Reimbursement Utilization Management Effects of Managed Care on Pharmacy Services Cost Management Through Care Management Managed Care Accomplishments The Future: Competition in Managed Care Chapter 6: The Health Professions Introduction Prescribing Authority Health Manpower Physicians Pharmacy Personnel and Practice Site Issues and Trends Appendix Chapter 7: Pharmacists in the U.S. Health Care System Introduction Pharmaceutical Care Manpower Historical Considerations Supply Demand Surplus or Shortage PEW Health Professions Commission Report Education Historical Considerations Increased Length of Curriculum Standardization of the Curriculum Clinical Pharmacy A Profile of Pharmacy Education Practice Settings Conclusion Chapter 8: Pharmacy Organizations Introduction Role of Pharmacy Organizations Historical Development of Pharmacy Organizations Specific Pharmacy Organizations Current Issues for Pharmacy Organizations Individual Decisions Regarding Organizations Chapter 9: Emerging Roles for Pharmacists Introduction: Historical Overview of the Pharmacist in the United States Health Care Issues in the United States Health Care Trends and New Opportunities for Pharmacists Pharmaceutical Care: Opportunities for the Pharmacist in the Future Expanded PC Model: Framework for Achieving Pharmaceutical Care in the Health Care System Needs/Challenges to Further Development of Pharmacy Practice and Implementation of Pharmaceutical Care Summary and Conclusions Chapter 10: Hospitals and Health Care Institutions History Modern Hospitals DRGs or Prospective Reimbursement Competition Services Offered Departments and Services Joint Commission on Accreditation of Health Care Organizations Summary Trends and Predictions Chapter 11: Pharmacists Involvement in Nursing Home Facilities and Home Health Care Increase in the Number of Elderly Increased Demand for Health Care Services Long-Term Care Facilities The Role of Consultant Pharmacists in LTCFs Cost Benefit of the Consultant Pharmacist Home Health Care Services Pharmacy Involvement with Home Health Care Agencies Chapter 12: The Pharmaceutical Industry Financial Statistics Sales and R&D U.S. Health Care Expenditures Market Entry of Alternatives Conclusion Chapter 13: Drug Distribution Introduction Distribution and Marketing Strategy Pharmaceutical Manufacturers Drug Wholesaling in the United States Concerns in the Wholesale Industry Repackagers Distribution in Large Community Pharmacies Alternative Distribution Channels Distribution of Generic Drugs Emerging Trends in Distribution Achieving Operational Efficiency Through Automation Conclusion Chapter 14: The Consumers of Health Care Introduction The Consumer Role Models of the Patient-Practitioner Relationship Consumerism in Health Care: The Changing Role of the Patient Health, Illness, and Sick-Role Behavior Ethnic and Cultural Differences in Illness Behavior Aging Americans: Impact on Health Care Consumer Behavior and Pharmacy Practice Chapter 15: The Drug Use Process Introduction Patient Compliance Summary Chapter 16: Provision of Care to Subpopulations: A Cultural Perspective Introduction Minorities: Diversity in the Health Care Fields Culture, Race, Ethnicity, and Health Care Cultural Sensitivity Epidemiology and Ethnic Variations Ethnic and Racial Difference in Treatment Outcome Variations Cultural Influences and Utilization of Pharmacy Health Services Culture and Treatment Compliance Conclusion Chapter 17: Pending Other Issues Introduction Pharmacy Technicians: By the Pharmacists Side Medication Errors: A Pharmaceutical Care Responsibility Rx to OTC: An Opportunity for Pharmacy and for Better Patient Care Pharmacy: An Introspective Look at Drug and Alcohol Dependence Challenges for Pharmaceutical Care Chapter 18: New Technologies Introduction Impact of Computer Technology on Pharmacy Practice Lifelong Learning with Computer Technology Information Technology versus Automation How Pharmacy Is Impacted by Technology Distribution Systems: Retail and Wholesale Practice Implications Where Do We Go From Here Index

Cost-Benefit Analysis A Research Tool for Evaluating Innovative Health Programs

This article reviews the evaluation methodology known as cost-benefit analysis. Studies which have utilized this technique are presented and briefly reviewed. In addition, the closely related technique known as cost-effectiveness (C-E) analysis is described and contrasted with cost-benefit analysis. Several research articles utilizmg C-E are described. It is recommended that cost-benefit analysis be used as a mechanism to evaluate innovative health programs. This may be the sole mechanism that will enable health practitioners to cost- justify their innovative services to the federal government and other third-party payers.

Prescription drug utilization review in the private sector.

With increased coverage of prescription drugs by health insurance plans, utilization data are now becoming available and there is renewed interest in drug utilization review (DUR) programs. This article describes the DUR programs now being conducted by private sector firms for health insurance plans. The programs were found to be highly automated and very efficient. Most firms estimate at least two to three dollar direct savings for each dollar invested in DUR. Much of this results from controlling overutilization and gaining compliance with drug formulary guidelines. In addition, the firms report finding drug therapy problems in about two to three percent of the enrollees receiving prescriptions.

An International Survey of Drug Information Centers

A questionnaire was developed to characterize the location, operation, personnel, reference resources, and functions of drug information centers in countries throughout the world other than the United States. The questionnaire was mailed to 100 drug information centers or pharmacy practitioners (primarily faculty) in 65 countries. The majority of drug information centers responding to this questionnaire were located at and funded by university based hospitals. Most were open eight hours per day and engaged in the following activities: answering requests for information, publishing pharmacy bulletins, teaching, continuing education, and providing information directly to pharmacy and therapeutics committees. Additional information gathered from this survey included: common references and journals maintained by drug information centers, user demographics, and a request profile. Although many similarities among the information centers were found, interesting observations regarding their differences may be made. It is important that drug information centers share their experiences so that others may learn about their new and innovative programs.

Using discriminant function analysis to estimate the impact of a therapeutic intervention in burn care

INTRODUCTION DURING the past few years, attempts have been made to develop baseline results of therapy for burned patients. These investigations have attempted to detect the influence of selected patient variables on the survival and morbidity of burn victims (Bull, 1971; Waisbren et al., 1975; Feller et al., 1976). Many of these studies have used probit analysis to determine the relationship between age, sex, body surface area burned, type of topical therapy used and others, as predictors of survival. McCoy et al. (1968) suggested that discriminant analysis (DA) might be useful in that it allows the incorporation of several predictor variables into a probability model. In 1975, Moores et al. described several discriminant functions (DF) and discussed the implications of using such a statistical tool. More recently, Clark et al. (1978) developed several discriminant functions to predict the survival of burned patients. They emphasized that discriminant function analysis offers more flexibility for examining and including potential predictor variables than does probit analysis. In addition, they point out that when using discriminant function analysis fewer cases are required to obtain accurate predictions. Finally, they suggest that discriminant analysis may be very useful in comparing patients receiving different treatment regimens, enabling medical personnel to make better decisions with regard to the management of burned patients. This investigation attempted to examine the value of discriminant analysis in measuring the relative impact of individualizing gentamicin dosage regimens in burned patients with Gramnegative septicaemia.

Professional socialization in pharmacy. A cross-sectional analysis of dominant value characteristics of agents and objects of socialization.

Abstract This paper presents the findings resulting from one portion of a broad study relating to the socialization of pharmacy students. Of specific interest in this component of the study was an analysis of the values demonstrated by the objects and agents of socialization in pharmacy on the Study of Values . The Study of Values was administered to preceptors and faculty persons in pharmacy and students representing four academic class levels. It was found that the socialization process in pharmacy does not alter the value structuring of student groups in terms of movement away from or toward those values held by preceptors and faculty. Independent differences between preceptors and students on the AESTHETIC, SOCIAL and RELIGIOUS value scales were detected. Furthermore, preceptors differed from faculty on their response to the SOCIAL value scale. However, these differences did not seem to contribute to a differential socialization pattern among students.

Multiple NSAID Prescriptions in a Medicare Managed Care Population

Objective: To describe the use of multiple nonsteroidal antiinflammatory drugs (NSAIDs) and the cost implications in a Medicare managed care population. Design: Retrospective analysis of prescription drug database records. Setting: Three Medicare managed care plans in the West and South. Patients: The population consisted of 22,544 patients who filled prescriptions for one or more different nonaspirin NSAIDs during a six-month period beginning March 1, 1998. Main Outcome Measure: Prescriptions for nonaspirin NSAIDs, misoprostol, proton-pump inhibitors, sucralfate, and analgesic drugs. Results: A total of 12.6% of individuals filled prescriptions for two different NSAIDs, and 2.3% filled prescriptions for between three and five different NSAIDs. As the number of NSAIDs increased from one to five, there was a decrease in the generic:brand-name ratio from 4.3:1 to 0.93:1, an increase in the total days supply from 39 to 310 days (for the 180-d period), an eightfold increase in the coprescription of misoprostol, a twofold increase in coprescription of analgesics, and an increase in payments per person for all NSAIDs and listed coprescribed drugs from

Maximum Allowable Cost: Can the Government Control Drug Costs? A Retrospective Political Analysis of Events and Issues

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