Thomas R. Sharpe

Medicine use among the rural elderly.

Direct and indirect relationships between predisposing, enabling and need-for-care factors and the use of prescribed and over-the-counter (OTC) medicine were examined among the rural elderly. Data were gathered through personal interviews conducted among a stratified random sample (based on geographic grids) of persons aged sixty or older residing in a northern Mississippi county. Findings showed that anxiety, perceived morbidity, and perceived availability of pharmacy services exerted direct effects on prescribed-medicine use, while several other predisposing and enabling factors exerted only indirect effects. The model derived for OTC-medicine use was much simpler: only anxiety and transportation exerted direct effects; anxiety and other predisposing variables exerted indirect effects through transportation. The model proved a better predictor of prescribedthan OTC-medicine use.

A Study of Pharmacists' Involvement in Drug Use by the Elderly:

Three hundred elderly persons in a single Mississippi county were interviewed to determine drug use patterns and relationships with pharmacists. Although three-fourths had used the same pharmacy for longer than five years, only one in six used that pharmacy as their usual source for over-the-counter (OTC) drugs. More than eight percent incorrectly identified the use of their prescription drugs and 140 instances of potential drug interaction were identified. Communications with pharmacists were limited, as only one-fifth had talked with the pharmacist at the time their last prescription was filled and only one in six mentioned the pharmacist as someone they would ask about prescription drugs.

Hypertension and stress: A preventive approach

Abstract The most common approach to hypertension treatment is medication. Medical treatment, however, has been plagued with serious problems regarding detecting cases and maintaining compliance. By definition, the high proportion of cases diagnosed as ‘essential hypertension’ points to our inability to identify the causes of hypertension. This suggests that a psychosocial rather than a medical approach is needed if prevention is to be obtained. Such a preventive approach, based on decreasing the effects of stress, is presented. The first step—identifying individuals over-reactive to stress—was tested using Spielbergers state-trait anxiety model. Employees in five industries were screened for high blood pressure. A systematic sample and all hypertensives (SBP ≥ 160 and/or DBP ≥ 95 mm Hg) completed the State-Trait Anxiety Inventory (STAI). A-Trait as a measure of individual reactiveness to stress showed a weak relationship to hypertension. A-State, a measure of situation specific anxiety, showed a strong relationship to blood pressure. Multiple regression analyses identified obesity and A-State as the two most important modifiable risk factors for inclusion in a preventive program.

The determinants of health services utilization in a rural community in Kenya

Abstract The principal objective of this paper is to delineate social, structural, and health policy aspects related to the use of childhood vaccinations in an area of Machakos, Kenya. Children who have had BCG and smallpox vaccinations are likely to have received all other immunizations. The scars of BCG and smallpox vaccinations were used to determine those children aged 0–4 years who had received preventive health care in the community. A multivariate analysis revealed six health behavior related components: demographic structure, cosmopoliteness, health consciousness, attitudes toward health care, awareness of modern health services and the presence of significant references. It is concluded that although the individual characteristics are important in the maintenance of health behavior and the use of preventive health services, the social structure and the health policy are far more important determinants of community health care.

An investigation of prescribed and nonprescribed medicine use behavior within the household context

The goal of this study was to study empirically individual and household characteristics and their relation to individual medicine use behavior. The study accounted for 40% of the variance in prescribed medicine use and 20% of the variance in nonprescribed medicine use behavior for 545 AFDC households in Northern Mississippi. Perceived morbidity was the primary mediator of medicine use and 57% of the explained variance in nonprescribed medicine use. Age was a significant contributor to the variance explained in prescribed medicine use behavior. The use of nonprescribed medicines by other members of the household also significantly enhanced individual nonprescribed medicine use. Although many of the other individual and household variables were significant predictors of medicine use behavior they contributed little to the total explained variance. Research concerning medicine use in the context of the household is in the initial stage of theory development.

Attitudes of pharmacy students towards psychosocial factors in health care.

An attitude scale was administered on a cross-sectional basis to pharmacy students in 3 professional years and alumni 1 year post-graduation. The instrument, previously used in a study of social awareness among Canadian health professional students, revealed, on application, that social attitudes tended to decline as students progressed through school. Students with prior degrees had generally higher scores. Male students generally held stronger views than did female students, whether favorable or unfavorable.

Patterns of medication use among children in households enrolled in the Aid to Families with Dependent Children program.

Summary: This study examined patterns of medication use among children in 791 families, in two counties in Mississippi, which had children enrolled in the Aid to Families with Dependent Children (AFDC) program. One-twelfth of the interviews were conducted each month via household interviews. Interviews were completed in 540 households containing 1616 children (48.8% male, 80.9% black). Thirteen percent had taken at least one prescription drug and 21.5% had taken at least one over-the-counter (OTC) drug in the previous 2 wk. Analgesics (29.4%), cough/cold remedies (19.2%), vitamins (15.7%), and anti-infectives (12.4%) accounted for three-fourths of the instances of drug use. Over three-fourths (76.4%) of the prescriptions were new and 61.2% were paid for by Medicaid. Approximately three-fifths (62.7%) of OTC medicine uses were with medications already on hand. For prescription medications the physician was the soure of information on use in 87.7% of uses. For OTC use, the comparable percentage was 24.6.

Government Regulation and the Believability of Prescription Drug Advertising: An Application of Attribution Theory and Test of Symbolic Impact

An experimental study was undertaken to assess the impact of governmental regulation on the believability of prescription drug advertising. The specific variables investigated were symbolic impact and fair balance. Mock advertisements were developed for four tricyclic antidepressant drugs. Symbolic impact was operationalized by portraying the advertisements as originating from U.S. medical journals (i.e., regulated) or Mexican medical journals (i.e., unregulated). Fair balance was operationally defined as the inclusion of a brief summary in the advertisement. A nonrandom sample of twenty-four physicians saw four advertisements representing the four treatment combinations. On a self-administered questionnaire, they indicated their confidence in the information contained in the advertisement. A two-factor, repeated measures randomized block factorial design was employed in the analysis. The results indicated that the presence of fair balance was significantly associated with higher levels of believability; the symbolic impact factor was non-significantly associated with believability.

Physician and Patient Factors Associated with Differences in use of New Versus Established Therapeutic Agents

AbstractThe purpose of this study was to examine a secondary source of data and attempt to identify physician and patient related factors which are associated with the prescribing of new prescription drugs. Eight drugs introduced to the general market between January, 1977 and December, 1980 were selected as “new drugs” for study. Study drug utilization was compared to that of established drugs of the same therapeutic categories to determine whether there were significant differences in the relative frequencies of use between the new drugs and the established drugs with respect to physician and patient characteristics. The major conclusions of the study were 1 that treatment variables (the drug(s) examined, patient’s disease and the treatment setting) are important considerations in establishing an association between prescribing behavior and physician and patient characteristics; (2) the use of secondary data sources to study these associations can serve a limited but useful function in an overall, compr...