Stephanie Y. Crawford

HEALTH OUTCOMES VARIABLES IMPORTANT TO PATIENTS IN THE TREATMENT OF ERECTILE DYSFUNCTION

PURPOSE Erectile dysfunction is underreported and the rate of noncompliance with therapy is high. The National Institutes of Health Consensus Conference on Impotence endorsed the need for outcomes research of the various approaches to treatment. The purpose of our exploratory study was to begin that process through identification of erectile dysfunction treatment outcomes variables that are important to men. MATERIALS AND METHODS The study format consisted of focus group meetings. The goal of the discussions was to identify variables that are important to men when choosing among and judging the success of treatment modalities for erectile dysfunction. After discussion participants were individually asked to identify the 10 variables that they considered important and rank the 5 most important variables. An importance score reflecting group consensus was calculated for each variable. RESULTS Success and negative outcomes were identified as the 2 most important outcomes variables for all treatment modalities. Participants defined success in several ways. The most important measures of success were cure, pleasure and partner satisfaction. Negative outcome was defined as negative consequences associated with treatment. CONCLUSIONS The focus group discussion assisted in identifying and defining outcomes variables important to patients with erectile dysfunction. We believe that understanding issues and outcomes important to such patients is necessary to increase compliance with treatment and, thereby, increase the success of treatment of this widespread condition.

The Impact of Medicare Part D on Out-of-Pocket Costs for Prescription Drugs, Medication Utilization, Health Resource Utilization, and Preference-Based Health Utility

OBJECTIVES To quantify the impact of Medicare Part D eligibility on medication utilization, emergency department use, hospitalization, and preference-based health utility among civilian noninstitutionalized Medicare beneficiaries. STUDY DESIGN Difference-in-differences analyses were used to estimate the effects of Part D eligibility on health outcomes by comparing a 12-month period before and after Part D implementation using the Medical Expenditure Panel Survey. Models adjusted for sociodemographic characteristics and health status and compared Medicare beneficiaries aged 65 and older with near elderly aged 55-63 years old. PRINCIPAL FINDINGS Five hundred and fifty-six elderly and 549 near elderly were included. After adjustment, Part D was associated with a U.S.

Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial

179.86 (p=.034) reduction in out-of-pocket costs and an increase of 2.05 prescriptions (p=.081) per patient year. The associations between Part D and emergency department use, hospitalizations, and preference-based health utility did not suggest cost offsets and were not statistically significant. CONCLUSIONS Although there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries during the first year after Part D, there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D during its first year of implementation.

Efficacy of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in the treatment of patients with hypercholesterolemia : A meta-analysis of clinical trials

OBJECTIVE To assess the effectiveness and sustainability of a 6-month Team Education and Adherence Monitoring (TEAM) intervention for black patients with hypertension in community chain pharmacies. DESIGN Cluster randomized trial. SETTING 28 chain pharmacies (14 TEAM and 14 control) in five Wisconsin cities from December 2006 to February 2009. PARTICIPANTS 576 black patients with hypertension. INTERVENTION Trained pharmacist-technician teams implemented a 6-month intervention using scheduled visits, Brief Medication Questionnaires (BMQs), and novel toolkits for facilitating medication adherence and pharmacist feedback to patients and physicians. Control participants received patient information only. MAIN OUTCOME MEASURES Refill adherence (≥80% days covered) and changes in systolic blood pressure (SBP), diastolic blood pressure, and blood pressure control using blinded assessments at 6 and 12 months. RESULTS At baseline, all patients had blood pressure of 140/90 mm Hg or more. Of those eligible, 79% activated the intervention (mean 4.25 visits). Compared with control participants at 6 months, TEAM participants achieved greater improvements in refill adherence (60% vs. 34%, P < 0.001), SBP (-12.62 vs. -5.31 mm Hg, P < 0.001), and blood pressure control (50% vs. 36%, P = 0.01). Six months after intervention discontinuation, TEAM participants showed sustained improvements in refill adherence ( P < 0.001) and SBP ( P = 0.004), though the difference in blood pressure control was not significant ( P < 0.05) compared with control participants. Analysis of intervention fidelity showed that patients who received the full intervention during months 1 through 6 achieved significantly greater 6- and 12-month improvements in refill adherence and blood pressure control compared with control participants. CONCLUSION A team-based intervention involving community chain pharmacists, pharmacy technicians, and novel toolkits led to significant and sustained improvements in refill adherence and SBP in black patients with hypertension.

Internet Pharmacy: Issues of Access, Quality, Costs, and Regulation

Recent studies have documented the long-term impact of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors on mortality and morbidity related to coronary heart disease, establishing the link between lowering cholesterol levels and reducing cardiac events. Our study was a comparative literature review and meta-analysis of the efficacy of four HMG-CoA reductase inhibitors-fluvastatin, lovastatin, pravastatin, and simvastatin-used in the treatment of patients with hypercholesterolemia. The data sources for our meta-analysis of the efficacy of these cholesterol-lowering agents were 52 randomized, double-masked clinical trials with at least 25 patients per treatment arm. The results showed all four agents to be effective in reducing blood cholesterol levels. We computed summary efficacy estimates for all published dose strengths for the four agents. Fluvastatin 20 mg/d reduced low-density lipoprotein cholesterol (LDL-C) levels by 21.0% and total cholesterol (total-C) levels by 16.4%; fluvastatin 40 mg/d reduced these levels by 23.1% and 17.7%, respectively. Lovastatin 20 mg/d reduced LDL-C levels by 24.9% and total-C levels by 17.7%; lovastatin 80 mg/d reduced these levels by 39.8% and 29.2%, respectively. Pravastatin 10 mg/d reduced LDL-C levels by 19.3% and total-C levels by 14.0%; pravastatin 80 mg/d reduced these levels by 37.7% and 28.7%, respectively. Simvastatin 2.5 mg/d reduced LDL-C levels by 22.9% and total-C levels by 15.7%; simvastatin 40 mg/d reduced these levels by 40.7% and 29.7%, respectively. The results of our meta-analysis can be used in conjunction with treatment objectives and comparative cost-effectiveness data for these agents to decide appropriate therapeutic alternatives for individual patients.

National survey of once-daily dosing of aminoglycoside antibiotics

Internet pharmacy has been the focus of heightened interest over the past 3 years since the first major Web site was introduced in the United States. This paper addresses issues pertaining to Internet pharmacies that sell prescriptions and other products to consumers at the retail level. The Internet pharmacy industry has shifted rapidly in the short time span. This paper begins with a summary of historical considerations and the shifting organization of Internet pharmacy. The advantages and disadvantages of online pharmacy practice are listed. Issues of access, quality, and cost are described. The challenges in regulation at the state and federal levels are presented. Advice to consumers is offered regarding the use of Internet pharmacy sites for purchasing prescription drug products.

Systems Factors in the Reporting of Serious Medication Errors in Hospitals

To evaluate the scope of once‐daily dosing of intravenous aminoglycoside antibiotics, a questionnaire was designed and mailed to a random sample of pharmacy directors at 500 acute care hospitals in the United States. The response rate was 68.4%. Nineteen percent of the respondents reported use of once‐daily dosing of aminoglycosides. Affiliation with a pharmacy residency program and the presence of a pharmacokinetic consultation service by the pharmacy department were associated with this practice (p<0.05). No other statistically significant differences were found. Reported indications, contraindications, and dosing were consistent with those found in the literature. The profession of pharmacy, as demonstrated by pharmacy residency programs and pharmacokinetic consultation services, appears to have been instrumental in implementing this method of dosing aminoglycosides.

Comparison of learning styles of pharmacy students and faculty members.

Underreporting of medication errors poses a threat to quality improvement initiatives. Hospital risk management programs encourage medication error reporting for effective management of systems failures. This study involved a survey of 156 medical-surgical hospitals in the United States to evaluate systems factors associated with the reporting of serious medication errors. Prior to controlling for bed size, a multivariate logistic regression model showed increased reporting of medication errors in hospitals with 24-h pharmacy services, presumably because of better error reporting systems. When number of occupied beds was included, the final model demonstrated bed size to be the only statistically significant factor. Increased reporting rates for serious medication errors warrant further evaluation, but higher error reporting may paradoxically indicate improved error surveillance. Results suggest that increased availability of pharmacist services results in opportunities for more diligent systematic efforts in detecting and reporting medication errors, which should lead to improved patient safety.

Co-Production of Prolonged, Complex, and Negative Services An Examination of Medication Adherence in Chronically Ill Individuals

Objectives. To compare dominant learning styles of pharmacy students and faculty members and between faculty members in different tracks. Methods. Gregorc Style Delineator (GSD) and Zubin’s Pharmacists’ Inventory of Learning Styles (PILS) were administered to students and faculty members at an urban, Midwestern college of pharmacy. Results. Based on responses from 299 students (classes of 2008, 2009, and 2010) and 59 faculty members, GSD styles were concrete sequential (48%), abstract sequential (18%), abstract random (13%), concrete random (13%), and multimodal (8%). With PILS, dominant styles were assimilator (47%) and converger (30%). There were no significant differences between faculty members and student learning styles nor across pharmacy student class years (p>0.05). Learning styles differed between men and women across both instruments (p<0.01), and between faculty members in tenure and clinical tracks for the GSD styles (p=0.01). Conclusion. Learning styles differed among respondents based on gender and faculty track.

Herbal product claims: boundaries of marketing and science

This study examines customer coproduction in a prolonged, complex, and negative service context—medication adherence in chronically ill individuals. We integrate services and medical perspectives to develop a novel theoretical framework of adherence as a nested system of coproduction behaviors, characterized by temporal and scope dimensions. Utilizing a qualitative approach, our findings point to two key insights about coproduction in the customer sphere. First, the enactment and form of regular-restricted, intermittent-intermediate, and irregular-expansive coproduction behaviors are determined by the characteristics of the customer sphere—that is, coproduction is contextualized. Second, the coproduction system in the customer sphere is complex and the different levels are interdependent. Our research contributes to the emerging literature on service coproduction by elucidating the behaviors through which customers strive toward adherence. The identified coproduction framework holds important implications for providers of prolonged and complex services and future research directions.