Browsing by Subject "Social and Administrative Pharmacy"

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Characteristics of Latino smokers in different stages of change living in Minnesota.
(2011-06) Castellanos, Jose William
Tobacco use among Latino communities living in Minnesota is a cause of concern due to their vulnerabilities. Recent immigrants face the stress of acculturation, immigration- related issues, inadequate health insurance access, lack of family and social networks, lack of knowledge about the short-and long-term consequences of exposure to second-hand smoke (SHS), and the absence of culturally-appropriate and linguistically-competent tobacco cessation programs. Tobacco cessation interventions have traditionally been designed and implemented for the mainstream population and then translated to be used among minority communities. This approach does not recognize the unique characteristics of smokers from other cultures and ethnic groups. For this reason, in order to develop culturally-appropriate and linguistically-competent smoking cessation interventions, it is necessary to understand and address the complexities of Latino tobacco users. In order to understand these characteristics, the Stages of Change (SOC) model was used to classify Latino smokers and former smokers into the preparation, contemplation, pre-contemplation, and maintenance stages of change. Objectives The objectives of this study are 1) to describe the characteristics of Latino tobacco smokers living in Minnesota; 2) to determine if there are significant differences between Latino smokers not willing to quit using tobacco, in the pre-contemplation SOC; Latino smokers willing to quit using tobacco, in the preparation SOC; and Latino former smokers in the maintenance SOC; by socioeconomic status and level of acculturation; self reported physical and mental health, consumption of fruits and vegetables, and physical activity; beliefs regarding smoking, positive aspects of smoking, and knowledge of tobacco-related diseases; attitudes and level of exposure to SHS; and the level of cigarette addiction and willingness to quit smoking; finally, the study will 3) identify significant characteristics of Latino smokers that would be relevant to develop culturally-competent and linguistically-appropriate tobacco cessation interventions. Methods This research is a cross sectional study, using secondary data from the Diverse Racial and Ethnic Groups and Nations (DREGAN) project, focused on adults, eighteen years old or older who self-identified as Latino or Hispanic, or born in a Latin-American country or who have a parent or grandparent born in a Latin-American country, who agreed to respond to the survey questionnaire. Minors of eighteen years old, who are not Latino or from Latino origin, or qualified respondents who refused to answer the survey questionnaire were excluded from the study. Definition of variables The SOC algorithm was used to address if there were relevant relationships between the independent variables and the SOC that could be used to design culturally-appropriate tobacco cessation programs. Using the DREGAN dataset, an analysis dataset was created by recoding and combining participant survey responses. Statistical analysis SPSS version 19.0 software was used to conduct all statistical analyses, including descriptive, bivariate and multivariate analysis. Descriptive statistics were performed to summarize the characteristics of the respondents. Percents, means, and standard deviation of the means were calculated for continuous variables. Numbers and percentages were calculated for categorical variables. The continuous variables were compared using one-way analysis of the variance (ANOVA), the dichotomous categorical variables were compared using Chi-square test, and the thricotomuos categorical variables were analyzed using order logistic regression. Variables that were moderately associated with the comparisons categories (p<0.1) were identified and analyzed using logistic regression controlling for age and gender to examine their association with smokers in the different stages of change. Results The study reported that current smokers are more likely to be men than ever smokers. Smokers in the maintenance SOC tend to be older than smokers in the preparation and pre-contemplation SOC, as well as those in the preparation compared to smokers in the contemplation and pre-contemplation SOC. Smokers in the maintenance SOC are more likely to be married or live in a marriage-like relationship than current smokers. Smokers who answered that they were uncomfortable asking for help to quit smoking are more likely to live with children under 18 years old. Never smokers are more likely to answer the survey in Spanish than ever smokers. Smokers who believed that they were unlikely to succeed if they wanted or decided to quit smoking are less likely to have friends from the same ethnic background than those who believed they were likely to succeed. Similarly, smokers in the preparation SOC are less likely to believe that smoking facilitates friendship than those in the pre-contemplation SOC. It was also found that never smokers and smokers in the maintenance SOC, compared to ever and current smokers, are less likely to be exposed and have their children exposed to SHS, be comfortable with others smoking around them, live in a house and ride in a car in which someone smokes; as well are more likely to live in a home and prefer to work where smoking is not allowed. Similarly, a lower percentage of smokers in the preparation SOC rode in a car in which someone smoked during the previous week and was exposed to SHS compared to smokers in the contemplation and pre-contemplation SOC. However, smokers who believed they were unlikely to succeed if they wanted to quit smoking are more likely to live in a house where someone smokes. Never smokers compared to ever smokers are less likely to report stressful events, major injury or illness during the previous year, and a belief that smoking relieves stress. Similarly, never smokers and smokers in the preparation SOC are less likely to believe that smoking provides pleasure than ever smokers and those in the pre-contemplation SOC, and smokers who answered they were unlikely to succeed if they decided to quit smoking are less likely to believe that people smoke because they want to. Smokers who answered they were unlikely to succeed if they wanted to quit smoking are less likely to exercise adequately than those who answered they were likely to succeed. On the contrary, smokers who disagree with the belief that the only way to stop smoking is through will power are more likely to report a major injury or illness during the previous year, and are more likely to have a normal body mass index (BMI) than those who agreed. Never smokers and smokers in the preparation SOC are less likely to report major change in the health of a relative during the previous year than current and smokers in the pre-contemplation SOC; similarly, smokers in the preparation SOC are less likely to report major change in family reunions during the previous year than smokers in the pre-contemplation SOC, and are more likely to report interesting things in their daily life than those in the pre-contemplation SOC. It was also found that never smokers and smokers in the maintenance SOC, compared to ever and current smokers, are more likely to believe that there are no positive aspects of smoking, and live in a home and work where smoking is not allowed. Similarly, never smokers are more likely to report happiness than ever smokers. Never smokers are more likely to believe that smoking causes heart disease than ever smokers. Similarly, smokers in the maintenance SOC are more likely to believe that smoking causes more harms than benefits than current smokers. However, smokers who disagree with the belief that the only way to stop smoking is through will power are less likely to believe that smoking causes more harms than benefits than those who agreed with those beliefs. The study also found that smokers in the maintenance SOC are less likely to smoke their first cigarette and smoke regularly after their 18th birthday than current smokers. However, a larger percentage of smokers in the preparation SOC smoked cigarettes regularly after their 18th birthday compared to those in the contemplation and pre-contemplation SOC. Smokers in the preparation SOC are more likely to believe that they would be very likely to succeed if they want or decide to stop smoking than those in the pre-contemplation SOC; similarly, a larger percentage of smokers in the preparation SOC does not enjoy smoking compared to smokers in the contemplation and pre-contemplation SOC. Finally, as expected, smokers who disagree with the belief that the only way to stop smoking is through will power are more likely to feel very comfortable asking for help to stop smoking than those who agreed with that belief. Conclusions The results show that Latino smokers living in Minnesota share some of the characteristics described by previous studies including high level of exposure to SHS, the trend to quit smoking when older, to smoke cigarettes and are not willing to quit when are exposed to stressful events, the belief that smoking facilitates friendship and provides pleasure, enjoyment of smoking, and negative expectations for successfully quitting smoking. These hypotheses should be tested in prospective intervention studies of smoking cessation interventions using the SOC algorithm, taking into account the prevalence of smoking differences between women and men and the causes of smoking. As the most accessible health care practitioner, pharmacists are in a privileged position to provide smoking cessation interventions, especially to Latino recent immigrants who do not know how to navigate the complex health care systems in the U.S. By learning the unique characteristics of Latino smokers, pharmacists will be able to address their needs and increase the possibilities for successful outcomes.
Chronic medication adherence: its association with health care costs.
(2011-07) Zhou, Siting
Effective treatment for high-prevalence chronic diseases requires medication adherence. Improved medication adherence increases medication utilization, which leads to higher pharmacy costs. However, higher adherence may reduce medical services use that result in decrease in overall health care costs despite the increase in pharmacy costs. The objective of this study was to examine the impact of medical adherence on health care costs. The secondary objective of this study was to assess the independent effect of consumer directed health plans (CDHPs) on health care costs. The study samples were three independent cohorts of individuals with the separate conditions of diabetes, hypertension and hypercholesterolemia, identified from a pharmacy benefits management company between January 1, 2007 and December 31, 2009. Medication adherence was measured using Proportion of Days Covered (PDC) endorsed by Pharmacy Quality Assurance (PQA). Health care costs were measured at two levels: all-cause and condition-specific. At each level, pharmacy, medical and total health care costs were calculated. The generalized linear model with a gamma log link was used to fit six statistical models for each disease cohort. Control variables included patients’ demographics, socioeconomic information, health status, health services utilization. There were 22,012 individuals in the diabetes cohort, 64,600 in the hypertension cohort and 59,003 in the hypercholesterolemia cohort. At all-cause level, increased PDC was significant associated with decreased medical costs across the three cohorts (p<0.05). At condition-specific level, increased PDC was significant associated with decreased medical costs in the hypertension and hypercholesterolemia cohorts (p<0.001), but with increased medical cost in the diabetes cohort (p<0.001). Due to the significant increase in pharmacy costs associated with higher PDC (p<0.001), total health care costs were increased (p<0.001) both at all-cause and condition-specific levels in each cohorts. Enrollment in CDHPs was generally associated with decreased medical, pharmacy, and total health care costs at all-cause and condition-specific levels across the three cohorts. As adherence increases, the savings in medical costs are not able to offset the increase in pharmacy costs. Therefore, measures that aim to reduce pharmacy cost while preserving or improving adherence are needed.
Educating for action: understanding the development of pharmaceutical care practitioners.
(2011-07) Losinski, Victoria
Pharmaceutical care, a professional health care practice in which a practitioners works with an individual to understand the patient's medication needs and works to identify, prevent, and resolve drug therapy problems, was recently adopted as the mission and professional practice of pharmacy. The skills, knowledge, and ethics required in order to provide pharmaceutical care have not been defined or integrated as the foundation for pharmacy curricula. This research aimed to define the educational experiences required to provide pharmaceutical care, develop a curricular conceptual framework grounded in pharmaceutical care, and identify learning strategies to support the development of the pharmaceutical care practitioner. A five component developmental research process was used to develop the conceptual framework. Observations and interviews were conducted with seven pharmaceutical care practitioners in Minnesota. From field notes, interviews, and existing literature a prototype for the curricular conceptual framework was developed and refined based on additional data analysis and feedback from a panel of pharmaceutical care experts. The resulting curricular conceptual framework consisted of two structures: the curricular content and the curricular foundation. The curricular content is comprised of the clinical knowledge, clinical skills, and patient knowledge. The curricular foundation consists of practice standards, patient care ethics, and teaching, application, and evaluation techniques. Each conceptual framework component is interrelated and interdependent on the other components. The research findings and resulting conceptual framework provide the initial, required components for the development of a pharmaceutical care based curriculum.
The intention to enroll in Medicare Part D:an analysis in the pre-medicare eligible population
(2012-01) Jin, Tao
Studies suggested that the wide range of drug plan options and the complexity of drug benefits in the Medicare Part D program might have discouraged the enrollment in the Medicare Part D program. This study used the Theory of Planned Behaviors (TPB) as the theoretical framework to understand pre-Medicare eligible individuals’ decisionmaking in the context of Medicare Part D enrollment. Specifically, the objective of this research were (1) to examine correlations between underlying beliefs with attitudes, subjective norms, and perceived behavioral controls variables in the model of the TPB; and (2) to evaluate the strengths of paths among attitudes, subjective norms, perceived behavioral controls, and intentions to enroll in the model of the TPB. This research included focused interviews, pretest study, pilot study, and main study. The instrument was established and evaluated in focused interviews, pretest study, and pilot study. Then a cross-sectional survey design was used in the main study and data was collected by mailed self-administered surveys. The survey was administered to a random sample of 1500 pre-Medicare eligible individuals (62-64 years) living in Minnesota. 689 surveys were returned; 556 out of these 689 surveys were eligible for inclusion criteria. The usable response rate was 40.67%. Descriptive statistics showed that generally pre-Medicare eligible individuals’ evaluations about Medicare Part D (Average score: 3.25 out of 5); their social pressure to enroll in Medicare Part D (Average score: 3.26 out of 5), and their perceived controllability (Average score: 3.34 out of 5) regarding the Medicare Part D enrollment were positive. In addition, their intention to enroll in Medicare Part D was moderately positive (Average score: 3.33 out of 5). Hierarchical regression analyses were employed to explore correlations between underlying beliefs (behavioral beliefs, normative beliefs, and control beliefs) and corresponding factors (attitudes, subjective norms, and perceived behavioral controls) preceding enrollment intentions. The results revealed that (1) “saving money on medications” (a=1.79, p<0.0001) was significantly associated with pre-Medicare eligible individuals’ attitude toward Medicare Part D and this outcome was perceived significantly beneficial for them. (2) “my spouse/significant other” (a=1.54, p<0.0001) and “my parents” (a=0.42, p=0.03) were perceived to approve of Pre-Medicare eligible individuals’ enrollment in Medicare Part D; however, their motivations to comply with their opinions were not significant; (3) Pre-Medicare eligible individuals believed that “mailing materials about drug plans” (a=0.4, p=0.0042) and “consulting with my pharmacy” (a=0.5, p=0.0056) would make is easier for them to enroll in Medicare Part D. Structural equation modeling methods (confirmatory factor analysis and path analysis) were applied to investigate associations between factors (attitudes, subjective norms, and perceived behavioral controls) analyses and pre-Medicare eligible individuals’ enrollment intentions. Results showed that (1) attitude (r=0.39 p<0.001) and subjective norm (r=0.44 p<0.001) were significantly associated with pre-Medicare eligible individuals’ enrollment intentions in Medicare Part D; (2) subjective norm was the stronger predictor (r=0.49) than attitudes (r=0.35) of enrollment intentions in Medicare Part D for male pre-Medicare eligible individuals. However, the difference was not obvious (r attitude-intention=0.42 vs. r subjective norm-intention=0.40) for female individuals; (3) the TPB model had a reasonable good fit of the data to predict Medicare Part D enrollment intentions (R2= 0.616). This study showed that a more favorable evaluation of the Medicare Part D program, and a stronger perception of relevant others’ beliefs regarding enrolling in Medicare Part D drug plans could result in a stronger enrollment intentions of pre- Medicare eligible individuals. This study took the initial step to understand the decisionmaking process surrounding the Medicare Part D program enrollment in those pre- Medicare eligible individuals. Based on an understanding of the decision-making process of the Medicare Part D enrollment, the impact of this study could be enhanced by proving social support for Medicare beneficiaries in enrolling in Medicare programs. However, there was considerable variability in the observed association between behavioral intentions and actual behaviors. Further research is needed to explore the stability between Medicare Part D enrollment intentions of pre-Medicare eligible individuals and their actual enrollment behaviors. That will be more meaningful.
The medication experience of people living with HIV: From the understanding of the meanings of medication to the development of a conceptual framework of medication experience.
(2012-06) Alves, Mateus Rodrigues
This is a study investigating the medication experience of people living with HIV/AIDS and the influences on the patient's relationship with medications. The study was conducted from April 2011 to April 2012. The methodology of investigation was Grounded Theory. The methods included one-to-one in-depth interviews, journaling, and observations. The participants in the study were nine people living with HIV. The results suggest that there are two dimensions of experiences associated with HIV drug therapy. One is the life disruption and the other is the meaning that the patient ascribes to medications. The results of this study are presented as a theoretical visual model. The model intends to show the complexities of living with HIV and the factors influencing the patient's relationship with medications in HIV drug therapy. The author recommends the use of narratives in patient care as a standard practice to understand the patient's medication experience. In addition, the proposed model can be used as a pedagogical tool to teach students in the health care disciplines as it portrays the complexities involved in HIV medication taking in a relatively simple manner. The findings of this study contribute to the illness experience as well as medication experience literature. Lastly, the proposed model can be applied to other illness contexts in which the use of medications is a key strategy for improving the patient's quality of life.
Regulating the unknown: Managing the occupational health risks of nanomedical technologies and nanopharmaceuticals in the research laboratory.
(2012-02) Ersin, Özlem Hacer
Novel technologies and their resultant products demand fresh ways of thinking about pre-market risk analysis and post-market surveillance. A regulatory framework that is responsive to emerging knowledge about the hazards of novel technologies offers repeatable and transparent processes and remains economically and socially feasible. Workers are an especially vulnerable population who are exposed to unknown hazards of novel technologies and serve often as unwitting sentinels of impending risks. This Grounded Theory-based case study identifies gaps in our current ability to regulate novel technologies so as to minimize occupational health risks and offers necessary modifications for an environment that is conducive to proper regulation. Nanopharmaceuticals and the nano-based technologies at their base are used by way of exemplar technologies that are currently taxing the ability of the regulatory system to provide adequate oversight. Ambiguities of definition, absence of a tracking system (of who is doing nanotechnology research), and the paucity of scientific evidence to support risk management efforts are among the findings of the study and need to be addressed as ameliorative steps toward an effective regulatory structure.
Sectoral and geographic mobility of the pharmacist workforce: trends and determinants
(2012-06) Yusuf, Akeem Adewale
The purpose of this study was to explore sectoral and geographic migration of the pharmacist workforce and to examine the occupational and non-occupational factors associated with this mobility. This study employed quantitative analysis of unique datasets to estimate the magnitude of pharmacist workforce migration, describe its temporal patterns and investigate the role of occupational and non-occupational factors as motivators for this phenomenon. Job history data from the 2000 and 2009 National Pharmacist Workforce Survey was used to investigate sectoral and geographic migration of pharmacists between 1980 and 2009 in the first section of the study while the 5% public use sample of the 2000 Census of the Population was employed to investigate geographic migration of pharmacists between 1995 and 2000 in the second section. The magnitude and temporal patterns of sectoral and geographic migration of pharmacists between 1980 and 2009 were described using non-parametric descriptive statistics while the motivators of sectoral and geographic migration of pharmacists during this period were investigated using survival analysis. Logistic regression analysis was used to examine the association between the odds of interstate migration and several occupational and non-occupational variables between 1995 and 2000. Out-migration of licensed pharmacists from large chain sector appeared to be greater than out-migration from independent/small chain and institutional sectors. When pharmacists migrate, they were more likely to move from their state of employment to another state within the same census region. Sectoral and geographic migration rates tended to be greater for female pharmacists compared to male pharmacists. Overall, absolute change across census regions between 1995 and 2000 advantage the south and the west regions. For pharmacists, the strongest factors related to migration were non-occupational variables such as age, having dependents and level of educational attainment. The occupational variables that were significant motivators of migration from one state to another included number of new pharmacy graduates and the change in the pharmacist per population ratio at the state level. The study concluded that state level pharmacy labor market conditions impact migration decisions and are thus a viable focus of policy interventions.

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