Robert S. Beardsley

Prescribing of Psychotropics in Elderly Nursing Home Patients

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one‐fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one‐fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Anticonvulsant serum levels are useful only if the physician appropriately uses them: An assessment of the impact of providing serum level data to physicians

Summary: The ability to measure serum levels of anticonvulsants has been a significant advance in the treatment of epilepsy. This technique enables practitioners to monitor a patients plasma concentration, to detect potential toxicity, and to assess compliance with the prescribed regimen. A retrospective study of 164 adults with epilepsy was conducted to evaluate how serum anticonvulsant determinations were used by physicians in their treatment of epilepsy. Results indicate that the availability of test results did not improve the degree of seizure control, nor did it diminish patient reports of toxicity. In 17% of therapeutic decisions, prescribers did not appear to use the blood levels appropriately in their therapeutic decision‐making process. When physicians did appropriately utilize information from serum levels, the degree of seizure control improved significantly compared with when the prescribers did not use this information. The cost of determining serum levels of anticonvulsants is justified only if the information is appropriately utilized.

English for Specific Purposes: Content, Language, and Communication in a Pharmacy Course Model.

After presenting an overview of content-area ESL and English for specific purposes (ESP), this article describes an experimental course in communication offered to nonnative English-speaking pharmacy students at the University of Maryland and reports the results of an evaluation of the course. A combination of content- area ESL and ESP, the course, which met weekly for one semester, was team-taught by a pharmacist specializing in communication for pharmacists and an ESL specialist. Speech functions deemed necessary for effective oral communication by pharmacists in their professional settings were used as an organizing principle for the syllabus, which also provided for instruction in relevant linguistic structures, for instruction in communication principles and techniques, and for much active student participation. Although better evaluation measures are needed, student evaluations and comparison of the results on pre-and posttests of the Speaking Proficiency English Assessment Kit (Educational Testing Service, 1982a) suggest that the course was effective.

Psychotropic Medication Prescription in U.S. Ambulatory Medical Care

Because of the pharmacologic power of psychotropic medications, the potential for adverse effects, and the changing popularity of particular psychotropic drugs, it is vital for pharmacoepidemiologists to monitor the prescribing patterns of these medications. Using data from the 1985 National Ambulatory Medical Care Survey (NAMCS), this article assesses psychotropic medication prescribing by U.S. ambulatory care physicians. Psychotropic medications are classified into three categories: Minor tranquilizers (i.e., anxiolytics and sedative-hypnotics), antidepressants, and antipsychotics. The prescribing patterns of psychiatrists, primary care clinicians, and all other physicians are compared. Differences in psychotropic prescribing patterns by psychiatric diagnosis are examined as well. The excessive use of minor tranquilizers, the continuing use of first-generation psychotropic medications (particularly minor tranquilizers), and the lack of concordance between diagnoses and prescribed psychotropic medications are discussed.

Recommendations for the Next Generation of Accreditation Standards for Doctor of Pharmacy Education

After each of the two series of plenary sessions at the September 2012 ACPE Conference on Advancing Quality in Pharmacy Education,1 attendees divided into five work groups (19 or 20 persons per group) for the purpose of drafting conference recommendations. The conference planning team selected five conferees as discussion facilitators and five ACPE staff members as recorders; these individuals were briefed on the purpose and process of the work groups. Conference planners chose topics for work-group discussion based on the conference objectives and the results of preconference surveys.2 Participants were asked to draw on background readings, the results of preconference surveys, and conference presentations to formulate conclusions or “findings”—observations, opinions, views, and perspectives—related to the specific issues assigned to a group. For example, one group was asked to identify “the top pharmacist competencies for current practice that you believe require additional attention in PharmD education,” and another group was asked a parallel question about “competencies for future practice.” Work groups convened twice—first for competency issues and then for assessment issues. Based on their findings, the groups drafted recommendations for consideration at the final plenary session. The conference planning team edited these drafts, striving for clarity and minimal redundancy, and prepared the final set of recommendations for scoring by all conferees.

The use of mental health measures in nursing home research

To examine the quality of mental health research in nursing homes, 130 articles published in six geriatric specialty and health care delivery journals were reviewed. Thirty‐nine (30%) articles used a mental health measure. Measures of cognitive function were most common, being used in 32 (25%) of the articles reviewed. Twenty‐three (18%) studies measured abnormal mental experiences and 17 (13%) articles measured behavioral disorder. Many articles used measures or determinations with no established reliability. Twenty‐six of the articles which used a mental health measure also used a measure of activities of daily living or physical function. Retrospective and prospective studies were similar in number. A minority of articles used control groups, random samples, or prepost measures while a majority (64%) identified an outcome measure. We conclude that nursing home research can be improved by the increased use of reliable measures of cognition and abnormal mental experiences and by the development of reliable measures of behavioral disorder. Study design can be improved by identifying a priori hypotheses and by the increased use of random sampling and control/comparison groups.

Antiparkinson Drug Adherence and Its Association with Health Care Utilization and Economic Outcomes in a Medicare Part D Population

OBJECTIVES We examine the associations of adherence to antiparkinson drugs (APDs) with health care utilization and economic outcomes among patients with Parkinsons disease (PD). METHODS By using 2006-2007 Medicare administrative data, we examined 7583 beneficiaries with PD who filled two or more APD prescriptions during 19 months (June 1, 2006, to December 31, 2007) in the Part D program. Two adherence measures--duration of therapy (DOT) and medication possession ratio (MPR)--were assessed. Negative binomial and gamma generalized linear models were used to estimate the rate ratios (RRs) of all-cause health care utilization and expenditures, respectively, conditional upon adherence, adjusting for survival risk, sample selection, and health-seeking behavior. RESULTS Approximately one-fourth of patients with PD had low adherence (MPR < 0.80, 28.7%) or had a short DOT (≤ 400 days, 23.9%). Increasing adherence to APD therapy was associated with decreased health care utilization and expenditures. For example, compared with patients with low adherence, those with high adherence (MPR = 0.90-1.00) had significantly lower rates of hospitalization (RR = 0.86), emergency room visits (RR = 0.91), skilled nursing facility episodes (RR = 0.67), home health agency episodes (RR = 0.83), physician visits (RR = 0.93), as well as lower total health care expenditures (-

Employer Expectations of New Pharmacy Graduates: Implications for the Pharmacy Degree Accreditation Standards

2242), measured over 19 months. Similarly, lower total expenditure (-

Gastroenterologists' prescribing of infliximab for Crohn's disease: A national survey

6308) was observed in patients with a long DOT versus those with a short DOT. CONCLUSIONS In this nationally representative sample, higher adherence to APDs and longer duration of use of APDs were associated with lower all-cause health care utilization and total health care expenditures. Our findings suggest the need for improving medication-taking behaviors among patients with PD to reduce the use of and expenditures for medical resources.

Results of the Pre-Conference Survey: ACPE Invitational Conference on Advancing Quality in Pharmacy Education

As part of its assessment of the professional degree accreditation standards in pharmacy, the Board of Directors of the Accreditation Council for Pharmacy Education (ACPE) desired feedback from employers of new graduates. Specifically, the Board wished to understand what employers from the most common sectors of practice (community, health system, and managed care) were expecting from new PharmD graduates in terms of competencies related to the specific practice areas. Having a better understanding of practice expectations of Doctor of Pharmacy (PharmD) graduates would assist the Board in its revisions of PharmD program standards. At the same time, this information would be valuable to schools and colleges of pharmacy as they continue to revise their curricula to better meet the needs of pharmacy practice. To achieve the desired feedback, ACPE initially reached out to the American Society of Health-System Pharmacists (ASHP) to establish a joint task force to identify a group of ASHP members that hire new graduates for entry level practice or for first year residency positions and identify their expectations.1 The methodology used to identify the desired competencies is described in the Methods section below. The information provided by the health system employers informed the 2011 revision of the guidelines to the ACPE accreditation standards.2 The ASHP-ACPE Task Force report was shared jointly with the National Community Pharmacy Association (NCPA) and the National Association of Chain Drug Stores Foundation (NACDSF) to engage a similar project to identify the expectations of community (independent and chain) employers.1 A similar project was undertaken with the help of the Academy of Managed Care Pharmacy (AMCP).1 The findings of these three reports describing the expectations of employers from the respective areas of pharmacy practice were included in the preparatory readings provided to participants of the ACPE Invitational Conference Advancing Quality in Pharmacy Education: Charting Accreditation’s Future held September 12-14, 2012 in Atlanta, GA.3 The purposes of this paper are: (1) To describe the common methodology used by three joint task forces to obtain the expectations of employers of new pharmacy graduates from various sectors of practice (2) To list the competencies of new graduates desired by employers for each of the studied sectors of practice (3) To compare and contrast the findings of the three task force reports (4) To evaluate the recommended competencies in the three task force reports against the ACPE Standards and Guidelines for Doctor of Pharmacy degree programs