Nile M. Khanfar

D-Optimal Mixture Design: Optimization of Ternary Matrix Blends for Controlled Zero-Order Drug Release From Oral Dosage Forms

ABSTRACT The objective of the present study was to develop a tablet formulation with a zero-order drug release profile based on a balanced blend of three matrix ingredients. To accomplish this goal, a 17-run, three-factor, two-level D-Optimal mixture design was employed to evaluate the effect of Polyox™ (X1), Carbopol® (X2), and lactose (X3) concentrations on the release rate of theophylline from the matrices. Tablets were prepared by direct compression and were subjected to an in vitro dissolution study in phosphate buffer at pH 7.2. Polynomial models were generated for the responses Y4 (percent released in 8 h) and Y6 (similarity factor or f2). Fitted models were used to predict the composition of a formulation that would have a similar dissolution profile to an ideal zero-order release at a rate of 8.33% per hour. When tested, dissolution profile of the optimized formulation was comparable to the reference profile (f2 was 74.2, and n [release exponent] was 0.9). This study demonstrated that a balanced blend of matrix ingredients could be used to attain a zero-order release profile. Optimization was feasible by the application of response surface methodology, which proved efficient in designing controlled-release dosage forms.

Characteristics of Physicians Who Frequently See Pharmaceutical Sales Representatives

Pharmaceutical sales representatives (PSRs) can impact physician prescribing. The objective of this study was to test a model of physician and practice setting characteristics as influences on decisions by physicians to see PSRs. A survey was sent to a random sample of 2000 physicians. Multiple linear regression analyses were used to test models for predicting influences on decisions to see PSRs frequently, defined as at least monthly. Independent variables included: presence of restrictive policy for pharmaceutical detailing, volume of prescriptions, gender, age, type of specialty, academic affiliation, practice setting size, and urban versus rural. The dependent variable was frequency of PSRs visits to physicians. Six hundred seventy-one responses were received yielding a response rate of 34.7%. Four hundred thirty-two physicians (79.5%) reported seeing PSRs at least monthly. The decision influence model was found to be significant. Primary care physicians and high-volume prescribers showed increased likelihood to see PSRs. Physicians practicing in settings that were small, urban, without restrictive policies for pharmaceutical detailing, and not academically affiliated were more likely to see PSRs frequently. This model of physician and practice characteristics is useful in explaining the variations in physicians’ characteristics who see PSRs frequently. These characteristics could be used to guide the development of future academic or counter-detailing initiatives to improve evidence-based prescribing.

Impact of Direct-to-Consumer Advertising (DTCA) on Patient Health-Related Behaviors and Issues

The pharmaceutical industry spends billions of dollars annually on direct-to-consumer advertising (DTCA). Patient perspectives on the impact of televised DTCA on health-related behaviors and issues were assessed by means of a 68-question survey. 58.6% of respondents believed that DTCA allowed consumers to have a more active role in managing their health. However, 27.6% felt DTCA caused confusion, and an alarming 17.8% of respondents stopped taking their medication because of concerns about serious side effects mentioned in DTCA. Overall, participants believed DTCA plays a useful role in health self-management; however, a considerable percentage thought that the cost outweighs the benefits.

Open-access publishing for pharmacy-focused journals.

PURPOSE Pharmacy-focused journals that are available in open-access (OA), freely accessible, hybrid, or traditional formats were identified. METHODS Relevant journals were accessed from PubMed, International Pharmaceutical Abstracts, EMBASE, and the Pharmacology and Pharmacy category of Thomson Scientific Journal Citation Reports. Criteria were established to select journals that satisfied the definition of pharmacy focused. Journals were assessed based on accessibility, copyright transfer requirements, and restrictions. If tracked, the journals impact factor (IF) was identified according to classification, and medians were calculated for each journal category. RESULTS A total of 317 pharmacy-focused journals were identified. The majority of pharmacy-focused journals identified were traditional/non-OA (n = 240). A smaller number of journals were freely accessible/ non-OA (n = 37), freely accessible/non-OA with content restrictions (n = 20), or freely available/non-OA with date restrictions (n = 18). The fewest number of journals were completely OA (n = 2). The median IF for the 185 journals whose IF was tracked was 2.029. The median IF for freely accessible and hybrid journals (n = 42) was 2.550, whereas the median IF for traditional journals (n = 143) was 1.900. CONCLUSION A very small number of pharmacy-focused journals adhere to the OA paradigm of access. However, journals that adopt some elements of the OA model, chiefly free accessibility, may be more likely to be cited than traditional journals. Pharmacy practitioners, educators, and researchers could benefit from the advantages that OA offers but should understand its financial disadvantages.

Influence on Consumer Behavior: The Impact of Direct-to-Consumer Advertising on Medication Requests for Gastroesophageal Reflux Disease and Social Anxiety Disorder

A 68-question Internet survey was used to determine the impact of televised direct-to-consumer advertising (DTCA) on consumer-initiated medication changes for the treatment of gastroesophageal reflux disease (GERD) and social anxiety disorder (SAD). Of the 427 respondents, 10% that viewed DTCA for GERD and 6% that viewed DTCA for SAD reported that they subsequently initiated a conversation with their physician. Nearly half of respondents, 47.4% for GERD and 40% for SAD, reported that a change in therapy occurred as a direct result of these discussions. Televised DTCA for these two drug classes can have a significant impact on patient-initiated prescription requests.

Patient attitudes toward community pharmacist attire.

The white coat has symbolized professionalism, while representing provider–patient fiduciary relationship. Although well described in the literature for physicians, few studies examine the impact of pharmacist attire on patients’ opinions regarding professionalism and trust. Therefore, understanding patient perceptions regarding pharmacist’s attire and its influence on comfort, confidence, trust, and professionalism may provide guidance on ways to enhance the quality of the provider–patient relationship. A 43-item Likert-type questionnaire was administered to 347 adults in a community pharmacy setting to determine preferences about the pharmacist’s attire, accessories, and body art incorporating 8 photographs depicting a male pharmacist in various degrees of dress formality (ie, casual to professional). Descriptive and inferential statistics were used to summarize and analyze the data. Survey respondents reported it was desirable/strongly desirable that pharmacists be dressed in a shirt and tie, dress shoes, white coat, and name tag (mean 4.21-4.72), whereas they should not be dressed in jeans, casual shoes, or have visible body art (mean 2.17-2.78). Over 86% of the respondents felt that a pharmacist with a white coat instilled feelings of comfort, confidence, trust, and professionalism. In a community pharmacy setting, a pharmacist wearing a white coat appears to be the mainstay in displaying professionalism and inspiring trust in adult patients.

Antecedents of Repurchase Intention: Propositions Towards Using Marketing Strategy to Mitigate the Attrition of Online Students

The purpose of this study is to explore the relationship between customer satisfaction, service quality, and the repurchase intention dimension of consumer loyalty within higher education. The influence of switching costs as a mediating variable is also examined. The setting for the study is the online learning facet of the higher education market. While the relationship between satisfaction, service quality, and loyalty are well known, there is a gap in the literature examining this relationship within higher education. A new research framework is proposed to illustrate the relationship between the independent, mediating, and the dependent variables, and five propositions are put forth.

Marketing Retail Health Clinics: Challenges and Controversies Arising From a Health Care Innovation

Since their founding in 2000, retail-based health care clinics, also called convenient care clinics, have flourished but continue to generate controversy. This article examines the literature with respect to the industrys background, establishment of industry standards, types of services offered, marketing of retail health clinics, industry growth with new target markets, and patient demographics. It also examines the growing relationship with insurers and third-party payers, quality-of-care concerns by medical associations, and legal regulations and their potential impact on industry growth nationwide.

E-prescribing: attitudes and perceptions of community pharmacists in Puerto Rico

E-prescribing may help reduce medical errors. Study objectives were to determine use, perceptions, and a model of adoption regarding e-prescribing. A questionnaire was developed and sent to pharmacists in Puerto Rico. Multiple regression analyses were used to test a model of influences on adoption. 438 pharmacists responded. The overall adoption model was significant. Perceived advantages had a positive influence on adoption. Pharmacist groups demonstrating higher adoption included: male > female, chain > independent, younger > older (all p < 0.05). Barriers had a negative influence (p = 0.01). The model employed here can help explain pharmacist adoption and integration of e-prescribing.

Self-reported influence of television-based direct-to-consumer advertising on patient seasonal allergy and asthma medication use: An internet survey

BACKGROUND Direct-to-consumer advertising (DDTCA) of medications, a marketing tool used by the pharmaceutical industry to increase patient awareness of products, affects both consumer behavior and, ultimately, physician prescribing practices. Billions of dollars are budgeted each year for DTCA, and its influence is far-reaching. However, little information is available about patient-initiated physician interactions in which television-bbased DTCA has played a role in consumer behavior. OBJECTIVE The objective of this study was to explore the influence of television-based DTCA on treatment changes in patient-initiated medication use. METHODS A 68-item survey instrument consisting of dichotomous, multiple-choice, and open-ended questions was constructed and sent to a convenience sample of US residents during 3 consecutive months ending in February 2005. The survey, which was accessed through an Internet link provided in the e-mail, was designed to capture data about patient perceptions and behaviors regarding television-based DTCA of prescription medications used for seasonal allergy and asthma as well as demographic information. Inferential and descriptive analyses were performed. Key tests included Crosstabs analysis and normal approximation to the binomial test with the z score. RESULTS Surveys were sent to 2500 individuals. A total of 427 valid surveys were returned for a 17.1% response rate. Of the 402 respondents (94.1%) who stated that they had seen DTCA for seasonal allergy medication, 50 (12.4%) said they had discussed the advertised medication with their physician and 22 of those discussions (44.0%) resulted in a change in treatment. Three hundred forty-two respondents (80.1%) stated that they had viewed DTCA for prescription asthma medications, and 23 of those respondents (6.7%) said that they had discussed the brand of asthma medication viewed on television with their physician. Those discussions resulted in a change in treatment for 9 respondents (39.1%). CONCLUSION Within th his limited, self-reported, survey sample, patient-initiated discussions with physicians regarding television-based DTCA of allergy and asthma medications resulted in a change of treatment in 44.0% and 39.1% of respondents, respectively.