Dick R. Gourley

PART 3. HUMANISTIC OUTCOMES IN THE HYPERTENSION AND COPD ARMS OF A MULTICENTER OUTCOMES STUDY

OBJECTIVE To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD). DESIGN Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used. SETTING Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center. INTERVENTIONS Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents. MAIN OUTCOME MEASURES Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL. RESULTS Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients. CONCLUSION Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model.

Clinical and Humanistic Outcomes of a Lipid Management Program in the Community Pharmacy Setting

OBJECTIVES To identify patients at risk for coronary artery disease (CAD) through a search of a community pharmacys prescription database, to screen and identify patients with elevated cholesterol and at risk for CAD, to enroll patients in a pharmacist-directed lipid management program, and to evaluate selected clinical and humanistic outcomes. DESIGN Randomized, pretest-posttest control groups. SETTING Independent community pharmacy in a suburban metropolitan area. PATIENTS 51 patients who were not at National Cholesterol Education Program low-density lipoprotein cholesterol (LDL-C) or defined triglyceride goals and who met inclusion criteria. INTERVENTION Pharmacist-directed lipid management program. MAIN OUTCOME MEASURES Clinical outcome measures included total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglyceride levels; achievement of LDL-C goal; and risk factor prediction scores. Humanistic outcome measures included patient satisfaction with pharmaceutical care and patient knowledge of hyperlipidemia. RESULTS LDL-C was decreased in the pharmacist intervention group (n = 25), compared with an increase in the control group at study end. HDL-C levels increased and triglyceride levels decreased in both groups. Of treatment group patients, 32% achieved their cholesterol goals, compared with 15% of control group patients. Risk factor prediction scores improved in the treatment group and worsened in the control group. The treatment groups hyperlipidemia knowledge scores improved significantly from pretest to posttest. Both treatment and control group patient satisfaction scores for the pharmacist investigator were favorable at study end. CONCLUSION Both treatment and control patients benefited from participating in this study. Patients enrolled in the lipid management program made greater improvements in their knowledge of hyperlipidemia, risk factor scores, and cholesterol levels.

An international capstone experience for pharmacy students.

This report describes the experiences of the University of Tennessee College of Pharmacy over 20 years with an international capstone educational experience for students. Although the university provides reciprocal opportunities to international students, this report focuses on the experiences of the college’s pharmacy students who have participated in the program. This capstone course is offered as an elective course in the advanced pharmacy practice experience (APPE) component of the college’s experiential program. Goals of the program and a brief description of its organizational structure are provided. Results of a structured student satisfaction survey and a survey covering the most recent 3 years of the program are presented. This program has greatly broadened participants’ cultural horizons and expanded their global view and understanding of the contributions of pharmacy to health care.

Does combining antiretroviral agents in a single dosage form enhance quality of life of HIV/AIDS patients? A cost-utility study.

BACKGROUND Combining various antiretroviral agents into one single dosage form has been a strategy to reduce pill burden and enhance medication adherence among human immunodeficiency virus /AIDS (HIV/AIDS) patients. OBJECTIVES This is a cost-utility study from a health care systems perspective comparing coformulated fixed dose (FXD) strategy versus multiple free dose combination (FRC) in antiretroviral therapy. METHOD The Medical Expenditure Panel Survey (MEPS) was used to identify HIV/AIDS patients with ≥2 active antiretroviral medications. Patients on FXD were matched in 1:1 ratio with the FRC group using propensity scores. All medical costs excluding those paid by patients and families were included. Utility was measured using SF-6D scores from the SF-12 questionnaire. Incremental cost-utility ratios (ICURs) were calculated using the mean annual estimates. A cost-effectiveness acceptability curve was determined using a Monte Carlo probabilistic simulation technique. RESULTS Nine FXD antiretroviral formulations approved by the U.S. Food and Drug Administration by 2005 was included in this study. One hundred seventy HIV/AIDS patients with ≥2 antiretroviral agents were identified from the MEPS database, of which 53% (n=92) were on FXD formulation. On matching, 70 patients from FXD had a match from the FRC group. No differences in sociodemographic and health status variables were observed between the matched groups. The mean annual cost was

Accessibility of antiretroviral therapy in Ghana: Convenience of access

15,766.15 for FXD patients and

Comparisons of changes over time in per capita health expenditures across racial and ethnic groups

11,875.21 for FRC patients. The mean utility gained by using FXD over FRC was 0.085; however, this difference was not statistically significant. The ICUR for the FXD treatment over FRC treatment was

Patterns of reporting health-related quality of life across racial and ethnic groups

45,540.49/quality-adjusted life years (QALYs). Probabilistic sensitivity analysis showed FXD to dominate FRC (>50% probability of being cost-effective) above the

Comparative Analysis of Health Care Expenditures and Presence of Mental Health Conditions of HIV-Affected Versus Non-HIV-Affected Children

40,000 threshold. CONCLUSION Although the cost-effectiveness of a single-pill strategy was within the acceptable willingness-to-pay threshold, the QALY difference were minimal. Further research is recommended to explore the long-term impact of the strategy.

PMS38 PREFERENCES AND WILLINGNESS TO PAY FOR OSTEOARTHRITIS TREATMENTS AMONG THE MEDICARE POPULATION

The convenience of accessing antiretroviral therapy (ART) is important for initial access to care and subsequent adherence to ART. We conducted a qualitative study of people living with HIV/AIDS (PLWHA) and ART healthcare providers in Ghana in 2005. The objective of this study was to explore the participants’ perceived convenience of accessing ART by PLWHA in Ghana. The convenience of accessing ART was evaluated from the reported travel and waiting times to receive care, the availability, or otherwise, of special considerations, with respect to the waiting time to receive care, for those PLWHA who were in active employment in the formal sector, the frequency of clinic visits before and after initiating ART, and whether the PLWHA saw the same or different providers at each clinic visit (continuity of care). This qualitative study used in-depth interviews based on Yins case-study research design to collect data from 20 PLWHA and 24 ART healthcare providers as study participants. • Reported travel time to receive ART services ranged from 2 to 12 h for 30% of the PLWHA. • Waiting time to receive care was from 4 to 9 h. • While known government workers, such as teachers, were attended to earlier in some of the centres, this was not a consistent practice in all the four ART centres studied. • The PLWHA corroborated the providers’ description of the procedure for initiating and monitoring ART in Ghana. • PLWHA did not see the same provider every time, but they were assured that this did not compromise the continuity of their care. Our study suggests that convenience of accessing ART is important to both PLWHA and ART healthcare providers, but the participants alluded to other factors, including open provider–patient communication, which might explain the PLWHAs understanding of the constraints under which they were receiving care. The current nation-wide coverage of the ART programme in Ghana, however, calls for the replication of this study to identify possible perception changes over time that may need attention. Our study findings can inform interventions to promote access to ART, especially in Africa.

Part 2. Clinical and Economic Outcomes in the Hypertension and COPD Arms of a Multicenter Outcomes Study

The study compared changes over time in health expenditures across race and ethnicity, using data from the Medical Expenditure Panel Survey. Changes from 1996-1997 to 2004-2005 were compared between non-Hispanic Whites (NHW) and non-Hispanic Blacks (NHB) and between NHW and Hispanic Whites (HW). Three expenditure measures were used: annual expenditures per capita, annual out-of-pocket expenditures per capita (OOPE), and OOPE as a proportion of family income per capita. A linear regression-based difference-in-difference model was analysed by including interaction terms between the latter time period and dummy variables for NHB and HW. NHW had higher increases in annual expenditures per capita than HW (