L. Douglas Ried

A psychosocial perspective in the explanation of patients' drug-taking behavior

The goal of this study was to examine the applicability of the Health Belief (HBM) and Theory of Reasoned Action (TRA) models in predicting drug-taking compliance behavior among female patients with uncomplicated urinary tract infections. Thirty-eight percent of the respondents were compliant, 25% finished all of their medication, but missed one or more doses during the course of therapy, and 37% did not finish all of their medication as directed. Two HBM and three TRA variables had a statistically significant relationship with compliance: barriers and benefits (HBM) and belief strength, outcome evaluation, and behavioral intention (TRA). HBM variables explained 10% of the variance in the compliance variable. Adding the TRA variables to the model explained an additional 19% of the variance. Social influence variables (normative expectations, motivation to comply, and subjective norms) had a significant influence in the prediction of behavioral intention, but not in the prediction of compliance behavior. Suggestions for improving compliance based on these findings include: simplification of drug therapy by customizing and simplifying the regimen, continued patient reminders of the therapys value, and benchmarks for patients to evaluate the success or failure of therapy. A frank and open discussion from the start of therapy about its complexity, the medications side effects, time and fiscal constraints, and other factors which may modify patients perception of the likelihood of compliance is an important key to improving patients compliance behavior.

Role of the pharmacist in preventing distribution of counterfeit medications

OBJECTIVEnTo provide an overview of the counterfeit medication problem and recommendations of a joint American Pharmacists Association (APhA) Academy of Pharmaceutical Research and Science and APhA Academy of Pharmacy Practice and Management taskforce.nnnDATE SOURCESnSciFinder and PubMed were searched from 1980 to March 2011 using the following keywords: counterfeit drug product, counterfeit medications, drug product authentication, drug product verification, and track-and-trace. Publications, presentations, and websites of organizations that research the counterfeit medication problem in the United States and other countries were reviewed. A representative from the security division of a pharmaceutical manufacturer and a representative from a supplier of anticounterfeiting technologies gave presentations to the taskforce.nnnSUMMARYnThe taskforce recommends that pharmacists (1) purchase medications from known, reliable sources; (2) warn patients of the dangers of purchasing medications over the Internet; (3) confirm with distributors that products were purchased from manufacturers or other reliable sources; (4) monitor counterfeit product alerts; (5) examine products for suspicious appearance; (6) work with the pharmaceutical industry, distributors, and the Food and Drug Administration (FDA) to close gaps in the supply chain, especially for drugs in short supply; (7) use scanning technology in the pharmacy as part of a prescription verification process; (8) educate themselves, coworkers, and patients about the risks of counterfeit medications; and (9) report suspicious medications to FDA, the distributor, and the manufacturer.nnnCONCLUSIONnThe consequence of a patient receiving a counterfeit medication in the United States could be catastrophic, and pharmacists must play an active role in preventing such an event from occurring.

A model for curricular quality assessment and improvement

The article describes a systematic assessment model and its potential application to a colleges ongoing curricular assessment activities. Each component of the continuous quality improvement model is discussed, including (1) the definition of a competent practitioner, (2) development of the core curricular competencies and course objectives, (3) students’ baseline characteristics and educational attainment, (4) implementation of the curriculum, (5) data collection about the students’ actual performance on the curriculum, and (6) reassessment of the model and curricular outcomes. Over time, faculty members involved in curricular assessment should routinely reassess the rationale for selecting outcomes; continually explore reliable and valid methods of assessing whether students have reached their learning goals; get legitimate support for assessment activities from faculty members and administration; routinely review curricular content related to attitudinal, behavioral, and knowledge-learning outcomes; and determine what to do with the collected assessment data.

A Path Analytic Examination of Differential Social Control Theory.

Differential social control theory was investigated with survey data from 860 adolescents using path analytic techniques. Peer non-use expectations, peer use, and the adolescents own attitude each have a direct influence on drug use. Peer non-use expectations have the largest total effect on drug use and are directly influenced by parental, peer, and school attachments. Students attitude has a direct effect on drug use, however, a majority of the association is spurious. Peers drug use has the largest, direct influence on drug use. The likelihood of adolescents associating with drug using friends is reduced by a close relationship with their parents and by knowing that their friends disapprove of drug use. The model explained 60 percent of the variance. Students do not use drugs if they are unwilling to jeopardize their relationship with their parents and non-using friends. They are also less likely to use drugs if they think their parents and friends disapprove of drug use and if their friends do not use drugs themselves.

Effect of therapeutic drug monitoring services on the number of serum drug assays ordered for patients: a meta-analysis

Summary: In order to quantify the impact of therapeutic drug monitoring (TDM) services on the average number of serum drug assays (SDAs) ordered for patients, a meta-analysis was conducted on the data collected from 16 published and unpublished studies. Overall, TDM has no effect on the number of SDAs ordered per patient. However, there were a number of moderator variables that influenced the results. In studies utilizing control groups for comparison, TDM service-monitored patients were ordered fewer SDAs than nonmonitored patients. When data from the same institution were collected before and after implementation of a TDM service, there was an increase in the number of SDAs per patient. Aminoglycoside patients monitored by a TDM service were ordered more SDAs and nonaminoglycoside monitored patients were ordered fewer SDAs than nonmonitored patients. When the pharmacy department determined when the SDAs were to be collected and adjusted the dose, monitored patients were ordered fewer SDAs than nonmonitored patients. However, when the pharmacy department did not have control of these parameters, the TDM patients were ordered more SDAs than nonmonitored patients. Methodologic limitations of the studies and their possible effects on the results are discussed.

Innovations in pharmacy practice: Peering into the crystal ball

1reviews three-dimensional (3D) drug delivery mechanisms that layer materials (i.e., ink) onto a substrate. In vivo uses of powder-based 3D printing techniques were identified in bone scaffold engineering, for example, where antibiotics are printed onto bone reconstructions, allowing greater control of their release profile. Other advantages of 3D drug printing include precise control of droplet size and medication dose, high reproducibility, complex drug release profiles, and personalized medication therapy. The authors conclude, “These technologies may transform pharmacy practice by allowing medications to be truly individualized and tailored specifically to each patient, although technical and regulatory hurdles remain.”

Stigma, conflict, and the approval of AIDS drugs.

A preliminary report questioning the efficacy of zidovudine (AZT) in the early treatment of Acquired Immunodeficiency Syndrome (AIDS) implicitly questions the expedited process by which AZT was approved. While the public historically has influenced drug policy, recent changes were brought about by activists threatening civil insurrection to expand access to unapproved treatments. Turners social conflict theory is used to explain the recent structural changes in the drug approval process in terms of the overt struggle for control over access to potentially life-saving drugs. This passion for change is shown to be a result of the stigma of the disease itself. Challenging the hegemony of the FDA was a mechanism by which activists coped with the imputed stigma of AIDS. While controversial, activism has increased access to new drugs and will have a far-reaching impact on how future drugs are approved.