Volume 03, Number 3, 2012

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    Market Diffusion of Extended Cycle Hormonal Contraceptives
    (University of Minnesota, College of Pharmacy, 2012-10) Schumacher, Megen Leeds; Pettia, Ashley Cetola; Wertheimer, Albert I
    Background: Extended cycle hormonal contraceptives (e.g. Seasonale, Seasonique) when introduced in 2003 were considered a very novel approach to contraception. The idea of manipulating the menstrual cycle so that women would experience just four menstruations a year was radical and was assumed to be responsible for the slow acceptance rate among the general public. Objective: This report analyzes two different aspects of the acceptance of this unique idea in the population. The first was the level of usage of extended cycle hormonal contraceptives in the general population, which was measured by a review of sales figures over time in the United States. The second was an examination of market diffusion as it relates to consumer perceptions regarding the characteristics of these products. Methods: To determine the degree of usage of extended cycle hormonal contraceptives the yearly sales, in terms of units sold, were compared with that of other leading methods of hormonal contraception. Along with the data, survey answers were obtained from 65 women who volunteered to participate in the study. Participants were selected randomly to represent the target population to assess the level of awareness about the benefits, risks, and any other concerns regarding the use of extended cycle hormonal contraceptives. Results: The yearly sales data of units sold showed a definitive increase in the sales of extended cycle hormonal contraceptives since their release on the market. The survey results showed an overwhelming awareness in the study population about the extended regimen. However, only about half of the women in the survey group were aware of its benefits. The main concern reported was the perceived significant side effect profile. Conclusion: Though awareness about the extended cycle hormonal contraception regimen was widespread, the survey population was not well informed about the advantages and the disadvantages regarding the degree of severity of side effects. To address these knowledge deficits, these aspects should be the focus when distributing information about extended cycle hormonal contraceptive regimens. This may
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    Using Think Aloud Protocols to Assess E-Prescribing in Community Pharmacies
    (University of Minnesota, College of Pharmacy, 2012-10) Odukoya, Olufunmilola K.; Chui, Michelle A.
    Introduction: Think aloud protocol has rarely been used as a method of data collection in community pharmacies. Purpose: The aim of the report is to describe how think aloud protocols were used to identify issues that arise when using e-prescribing technology in pharmacies. In this paper, we report on the benefits and challenges of using think aloud protocols in pharmacies to examine the use of e-prescribing systems. Methods: Sixteen pharmacists and pharmacy technicians were recruited from seven community pharmacies in Wisconsin. Data were collected using direct observation alongside think aloud protocol. Direct observations and think aloud protocols took place between January-February, 2011. Participants were asked to verbalize their thoughts as they process electronic prescriptions. Results: Participants identified weaknesses in e-prescribing that they had previously not conceived. This created heightened awareness for vigilance when processing e-prescriptions. The main challenge with using think aloud protocols was due to interruptions in the pharmacies. Also, a few participants found it challenging to remember to continue verbalizing their thought process during think aloud sessions. Conclusion: The use of think aloud protocols as method of data collection is a new way for understanding the issues related to technology use in community pharmacy practice. Think aloud protocol was beneficial in providing objective information on e-prescribing use not solely based on pharmacist’s or technician’s opinion of the technology. This method provided detailed information on a wide variety of real time challenges with e-prescribing technology use in community pharmacies. Using this data collection method can help identify potential patient safety issues when using e-prescribing and suggestions for redesign.
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    Withdrawing Drugs in the U.S. Versus Other Countries
    (University of Minnesota, College of Pharmacy, 2012-10) Ninan, Benson; Wertheimer, Albert I
    Since 1979, the United Nations has maintained a list of drugs banned from sale in member countries. Interestingly, there are a number of pharmaceuticals on the market in the USA that have been banned elsewhere and similarly, there are some drug products that have been banned in the United States, but remain on the market in other countries. This report provides a look into the policies for banning drug sales internationally and the role of the United Nations in maintaining the master list for companies and countries to use for local decision guidance.
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    Commentary for Medication Adherence of Patient Assistance Program Recipients: A Pilot Study
    (University of Minnesota, College of Pharmacy, 2012-10) Rickles, Nathaniel M.
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    Medication Adherence of Patient Assistance Program Recipients: A Pilot Study
    (University of Minnesota, College of Pharmacy, 2012-10) Conley, Christian S.; Hughes, Peter J.
    Purpose: Evaluate medication adherence of prescription assistance program recipients at an inner-city clinic. Methods: Surveys were administered at enrollment and 6 months following enrollment to patients who were either recipients of at least one patient assistance program (PAP) or had prescription benefits through Alabama Medicaid. Data on patient demographics, Morisky Medication Adherence Survey (MMAS) scores, mean possession ratio (MPR), and drug classes were collected for 6 months. Results: The baseline MMAS score concluded that both the PAP group and Alabama Medicaid group were highly motivated and highly knowledgeable regarding adherence to prescribed medications. After 6 months, administration of the same MMAS instrument resulted in a category change in the PAP group from highly motivated and knowledgeable to low motivation and high knowledge. The Medicaid MMAS adherence category did not change from baseline after 6 months. The 6-month mean MPR for the PAP and Medicaid groups were 0.542 and 0.823, respectively. Conclusion: Providing free or low-cost medication plus customary counseling should not be the sole interventions for the uninsured patient. In this study, PAP recipient MMAS score change and low mean MPR suggest that additional interventions are needed to ensure that PAP recipients adhere to prescribed therapies.
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    Building Community Pharmacy Work System Capacity for Medication Therapy Management
    (University of Minnesota, College of Pharmacy, 2012-10) Schommer, Jon C.; Goncharuk, Katerina; Kjos, Andrea L.; Worley, Marcia M.; Owen, James A.
    Questions within and outside of the pharmacy profession frequently arise about a community pharmacy’s capacity to provide patient-care services and maximize contributions to public health. It is surmised that community pharmacy locations must possess specific attributes and have identifiable resources within the location to effectively initiate and optimize their capacity to deliver patient care services in conjunction with medication distribution and other services. The purpose of this paper is to describe three research domains that can help pharmacies make the transition from “traditional” business models to “patient care centered” practices: (1) Work System Design, (2) Entrepreneurial Orientation, and (3) Organizational Flexibility. From these research domains, we identified 21 Work System Design themes, 4 dimensions of Entrepreneurial Orientation, and 4 types of Organizational Flexibility that can be used in combination to assist a practice location in transforming its business model to a “patient care centered” practice. The self-assessment tools we described in this paper could help realign an organization’s activities to initiate and optimize capacity for patient care.
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    Clinical Pharmacy: A Theoretical Framework for Practice
    (University of Minnesota, College of Pharmacy, 2012-10) Adjei, Michael
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    Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders’ Perspectives
    (University of Minnesota, College of Pharmacy, 2012-10) Elrod, Shara; Snyder, Margie E.; Hall, Deanne; McGivney, Melissa A. Somma; Smith, Randall B.
    Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4), support staff (n=2), collaborating providers (n=4), patients (n=3), and a payer (n=1). Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy’s practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy’s successful establishment of a patient care practice.