E. Paul Larrat

Use of Potentially Inappropriate Drugs in Nursing Homes

Study Objectives. To examine patterns and determine predictors of inappropriate drug use in nursing homes.

Compliance-Related Problems in the Ambulatory Population

When prescription drugs are taken in the correct dose and the correct manner, they have great potential for improving the quality of medical care, but inappropriate and incorrect administration of these drugs can lead to severe health problems. Risk factors for problems related to prescription drug compliance were examined in a cross-sectional retrospective study (n = 1017) of ambulatory individuals who had undergone a Brown Bag Prescription Evaluation Program consultation. A pharmacist interviewer assessed drug-related problems such as duplication of drug product, overutilization and underutilization of medication, drug interactions, and side effects. Associations between specific medication-related problems and patient characteristics (demographics, medical history, and insurance status) were studied. Factors that appear to be associated with compliance problems include a patients level of understanding of both medication instructions and the drug therapy, length of time since last physician visit, length of time on medication, total number of medications, and number of drug allergies. The class of medication taken was also found to be a significant predictor of excess risk. The age and sex of an individual appear to have little association with the development of compliance-related problems. The study reinforces the need for frequent patient contact with a health care professional and the value of educating the patient about the medication regimen.

Psychotropic Use Among Older Residents of Board and Care Facilities

OBJECTIVE: To describe patterns of psychotropic use as well as clinically relevant and concurrent nonpsychotropic use among older residents of board and care facilities in 10 states.

Screening for Peripheral Arterial Disease: Tifflely use of the Leg Alert protocol in ambulatory patients can save lives.

Peripheral arterial disease (PAD) is an age-dependent condition that limits ambulation and compromises quality of life in an estimated two million Americans. Early detection and treatment is essential for minimizing the signs and symptoms of PAD. Using a methodology developed by the National Council on the Aging, a noninvasive screening program was conducted for this disease in a population of 1,092 elderly ambulatory Rhode Island residents. Possible PAD was detected in 17.7% of the subjects, while 42% were identified as being at high risk for the disease.

An Innovative Approach to Pharmacy Management in a State Correctional System

Numerous models are employed for medication distribution and pharmacy services management in correctional facilities. Since 2003, the University of Rhode Island College of Pharmacy and the Rhode Island Department of Corrections (RIDOC) have collaborated on a pharmacy management program designed to better integrate medical care, improve medication utilization, and reduce pharmaceuticals costs. The program introduced staff education, waste-reduction strategies, treatment protocols, and a responsive formulary system. RIDOC pharmaceutical expenditures grew at a rate of approximately 1.5% Per Inmate Per Year from 2003 to 2009, considerably below the annual pharmaceutical inflation rate. Analyses of projected and actual drug spending indicate that RIDOC benefited from savings of almost

Physicians' knowledge and attitudes toward scheduling

5 million during this period. This innovative approach to pharmacy management addressed many pharmaceutical care issues that had challenged RIDOC while providing educational opportunities for doctor of pharmacy students in this practice setting.

Principles and Approaches to Pharmacoeconomics: The Perspective of Higher Education*

Objective: To determine physicians’ knowledge and attitudes of medico-legal issues regarding drug scheduling. Methods: The cross sectional survey was designed to assess attitudes and mailed to 400 randomly selected physicians. Results: A total of 155 (43.8%) of the 354 delivered surveys were returned. Physicians across all groups provided consistent responses suggesting a negative attitude about scheduling, a lack of understanding of scheduling issues and a harmful impact of scheduling on their practice. Physicians who saw 20 or more patients differed significantly from the other groups in 50% (4 of the 8) questions suggesting enhanced dissatisfaction.

Development of Alzheimer's disease special care units on a statewide level

The emergence of pharmacoeconomics as a vital and evolving discipline presents a unique challenge and opportunity to researchers in university settings. Although pharmacoeconomics offers the academician a fertile area for research, teaching, and service endeavors, several barriers exist which impact growth in this area. These include the ability of higher education to respond rapidly to funding opportunities, the lack of trained individuals to develop research programs, competition with other entities for these scarce human resources, problematic collaborative relationships with these same organizations, and the ability to initiate and conduct research in an unbiased arena. This paper outlines opportunities available to academic pharmacoeconomic researchers, challenges which may inhibit the maturation of this discipline, and potential strategies for addressing these challenges.

Update on the Treatment of Alzheimer's Disease: Drug therapy can ameliorate the behavioral manifestations of this disease.

The Alzheimer Demonstration Project of Rhode Island is a statewide effort to nurture the development of Alzheimers disease special care units in both public and private long term carefacilities. Since 1986, the effort has resulted in the establishment of eight special care units, the training of over four hundred health care professionals in both nursing homes, senior citizen centers and adult day carefacilities, the education and involvement offamily caregivers, and the implementation of a research protocol designed to evaluate the effectiveness of these facilities in improving patient outcomes. The project team has also developed special activity programsfor Alzheimers disease residents, protocols for medication, regimen evaluation and alteration, as well as training materials for professional and family caregivers. Initial resultsfrom the research component of this project document positive effects on medication use, resident survival time and residentfunctional status.

Persistence with lipid-lowering therapy: influence of the type of lipid-lowering agent and drug benefit plan option in elderly patients.

The research and clinical experience of the past decade have provided a wealth of new knowledge about the causes of AD and the treatment of individuals afflicted with this progressive, irreversible illness. Public awareness of the costs of the disease has increased both at a national level and at a family and individual level. Despite these advances, the care and treatment of the AD patient are complex in that the risks of therapy often outweigh benefits. The pharmacists can play a key role by ensuring rational therapy, providing professional support to AD care givers, and serving as a source of information in both the ambulatory and institutional patient settings.