Publications by authors named "Song Hee Hong"

33 Publications

Comparative effectiveness of budesonide inhalation suspension and montelukast in children with mild asthma in Korea.

J Asthma 2020 12 6;57(12):1354-1364. Epub 2019 Aug 6.

College of Pharmacy, Seoul National University, Seoul, Republic of Korea.

The comparative effectiveness of low-dose budesonide inhalation suspension (BIS) versus oral montelukast (MON) in managing asthma control among children with mild asthma was assessed in Korea. Claims from Korea's national health insurance database for children (2-17 years) with mild asthma (GINA 1 or 2) who initiated BIS or MON during 2015 were retrospectively analyzed. Pre- and post-index windows were 1 year each. Adherence, persistency, asthma control, asthma-related health-care resource utilization, and costs were evaluated using unadjusted descriptive statistics and propensity score-matched regression analyses. The number of children identified was 26,052 for unmatched ( = 1,221 BIS;  = 24,831 MON) and 2,290 for matched populations ( = 1,145 per cohort). Medication adherence, measured by proportion of days covered, was low for both cohorts but significantly higher for MON versus BIS (13.8% vs. 4.5%;  < .001). Time to loss of persistency was longer for MON versus BIS (82.3 vs. 78.4 days, respectively;  < .001). Mean number of post-index asthma-related office visits was 6.6 for BIS versus 8.3 for MON ( < .001). However, a greater proportion of patients in the BIS cohort had an asthma exacerbation-related office visit than the MON cohort (78.3% vs. 56.1%;  < .001). Asthma-related total health-care costs were higher with MON versus BIS (₩ 190,185 vs. ₩ 167,432, respectively;  < .001), likely driven by higher pharmaceutical costs associated with MON (₩ 69,113 vs. ₩ 49,225;  < .001). Montelukast patients had better adherence, a longer time to loss of persistency, and were less likely to experience an exacerbation-related office visit in the post-index period than BIS patients.
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http://dx.doi.org/10.1080/02770903.2019.1648504DOI Listing
December 2020

Risk of Kidney Dysfunction from Polypharmacy among Older Patients: A Nested Case-Control Study of the South Korean Senior Cohort.

Sci Rep 2019 07 18;9(1):10440. Epub 2019 Jul 18.

College of Pharmacy, Seoul National University, Seoul, Korea.

Polypharmacy, the concurrent use of multiple medicines, could increase the risk of kidney dysfunction among older adults because it likely burdens the aging kidneys to excrete multiple pharmaceutical ingredients and their metabolites. This study aimed to examine the relation between polypharmacy and kidney dysfunction among older patients. A nested case-control study was conducted using the National Health Insurance Service - Senior Cohort (NHIS-SC, 2009-2013), representative of the Korean senior population. It consisted of all health insurance claims linked to records of mandatory health examination. Kidney dysfunction was defined as having an eGFR lower than 60, with a decline rate of 10% or more compared to the baseline eGFR. Polypharmacy was defined based on daily counts of pharmaceutical ingredients during one year prior to the case's event date. It was classified into polypharmacy (five to 10 ingredients) and excessive polypharmacy (10 or more ingredients). After matching case and control groups based on a range of potential confounders, conditional logistic regression was performed incorporating adjustments on disease-specific, medication-specific, and lifestyle-related risk factors. The matching resulted in 14,577 pairs of cases and controls. Exposure to polypharmacy was significantly associated with increase in the risk of kidney dysfunction; i.e., crude model (polypharmacy: OR = 1.572, 95% CI = 1.492-1.656; excessive polypharmacy: OR = 2.069, 95% CI = 1.876-2.283) and risk adjustment model (polypharmacy: OR = 1.213, 95% CI = 1.139-1.292; excessive polypharmacy: OR = 1.461, 95% CI = 1.303-1.639). The significant associations were robust across different definitions of kidney dysfunction. These findings inform healthcare providers and policy makers of the importance of polypharmacy prevention to protect older adults from kidney dysfunction.
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http://dx.doi.org/10.1038/s41598-019-46849-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639333PMC
July 2019

Potential for physician communication to build favorable medication beliefs among older adults with hypertension: A cross-sectional survey.

Authors:
Song Hee Hong

PLoS One 2019 7;14(1):e0210169. Epub 2019 Jan 7.

Social and Administrative Pharmacy, College of Pharmacy, Seoul National University, Seoul, Korea.

Older adults suffering from hypertension form firm medication beliefs through lifetime medication management, which significantly affect their medication adherence and treatment outcomes. Understanding whether the patient-physician communication has the potential to change medication beliefs will help design an effective communication strategy to foster favorable medication beliefs. This study aims to determine whether the patient-physician communication is associated with medication beliefs among older adults with hypertension and controls socio-demographics and clinical characteristics. Further, it examines how the association varies with two different types of medication beliefs (medication overuse and harm) for each domain of communication (informative and interpersonal). A self-administered cross-sectional survey was conducted for members of seven senior centers in a metropolitan area of the United States between August and December of 2013. A total of 211 senior members suffering from hypertension completed the questionnaire, which included the Primary Care Assessment Survey (PCAS) and the Beliefs about Medicines Questionnaire (BMQ). The former had two domains of patient-physician communication-informative and interpersonal-while the latter measured medication harm and overuse beliefs. Interpersonal patient-physician communication significantly explained the medication overuse beliefs (β = -0.28, p < 0.05), whereas neither interpersonal nor informative communication significantly explained the medication harm beliefs. Females (β = 1.29, p < 0.01) and participants with higher education (β = 2.66, p = 0.02) more strongly believed that medications are overprescribed. However, participants with low income more strongly believed that medications are harmful. Patient-physician communication, if it touches upon interpersonal aspects, has the potential to change medication overuse beliefs among older adults with hypertension. Identification of the significant factors which affect medication beliefs, will inform the design of a patient-centric communication program that fosters favorable medication beliefs among geriatric hypertensive patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210169PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322726PMC
September 2019

Identification of Primary Medication Concerns Regarding Thyroid Hormone Replacement Therapy From Online Patient Medication Reviews: Text Mining of Social Network Data.

J Med Internet Res 2018 10 24;20(10):e11085. Epub 2018 Oct 24.

Research Institute of Pharmaceutical Science, College of Pharmacy, Seoul National University, Seoul, Republic Of Korea.

Background: Patients with hypothyroidism report poor health-related quality of life despite having undergone thyroid hormone replacement therapy (THRT). Understanding patient concerns regarding levothyroxine can help improve the treatment outcomes of THRT.

Objective: This study aimed to (1) identify the distinctive themes in patient concerns regarding THRT, (2) determine whether patients have unique primary medication concerns specific to their demographics, and (3) determine the predictability of primary medication concerns on patient treatment satisfaction.

Methods: We collected patient reviews from WebMD in the United States (1037 reviews about generic levothyroxine and 1075 reviews about the brand version) posted between September 1, 2007, and January 30, 2017. We used natural language processing to identify the themes of medication concerns. Multiple regression analyses were conducted in order to examine the predictability of the primary medication concerns on patient treatment satisfaction.

Results: Natural language processing of the patient reviews of levothyroxine posted on a social networking site produced 6 distinctive themes of patient medication concerns related to levothyroxine treatment: how to take the drug, treatment initiation, dose adjustment, symptoms of pain, generic substitutability, and appearance. Patients had different primary medication concerns unique to their gender, age, and treatment duration. Furthermore, treatment satisfaction on levothyroxine depended on what primary medication concerns the patient had.

Conclusions: Natural language processing of text content available on social media could identify different themes of patient medication concerns that can be validated in future studies to inform the design of tailored medication counseling for improved patient treatment satisfaction.
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http://dx.doi.org/10.2196/11085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231751PMC
October 2018

The mediatory role of medication adherence in improving patients' medication experience through patient-physician communication among older hypertensive patients.

Patient Prefer Adherence 2017 5;11:1119-1126. Epub 2017 Jul 5.

Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea.

Background: Understanding how patient-physician communication affects patients' medication experience would help hypertensive patients maintain their regular long-term medication therapy. This study aimed to examine whether patient-physician communication (information and interpersonal treatment) affects patients' medication experience directly or indirectly through changing medication adherence for each of the two communication domains.

Methods: A self-administered cross-sectional survey was conducted for older patients who had visited a community senior center as a member. Two communication domains were assessed using two subscales of the Primary Care Assessment Survey. Medication adherence and experience were measured using the Morisky Medication Adherence Scale and a five-point Likert scale, respectively. Mediatory effects were assessed via Baron and Kenny's procedure and a Sobel test.

Results: Patient-physician communication had a positive prediction on patients' medication experience (β=0.25, =0.03), and this was fully mediated by medication adherence (=3.62, <0.001). Of the two components of patient-physician communication, only informative communication showed a mediatory effect (=2.21, =0.03).

Conclusion: Patient-physician communication, specifically informative communication, had the potential to improve patients' medication experience via changes in medication adherence. This finding can inform health care stakeholders of the mediatory role of medication adherence in ensuring favorable medication experience for older hypertensive patients by fostering informative patient-physician communication.
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http://dx.doi.org/10.2147/PPA.S137263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505608PMC
July 2017

Effects of Specialty Pharmacy Care on Health Outcomes in Multiple Sclerosis.

Am Health Drug Benefits 2016 Nov;9(8):420-429

Professor, Department of Clinical Pharmacy, University of Tennessee Health Science Center.

Background: Increasingly, third-party payers are requiring patients with multiple sclerosis (MS) to participate in specialty pharmacy management programs to improve their adherence to their prescribed medications. The effects of specialty pharmacy care on MS clinical outcomes have not yet been comprehensively examined in the literature.

Objective: To compare the effectiveness of specialty pharmacy care and usual community pharmacy care MS outcomes.

Methods: Inpatient, outpatient, and pharmacy claims for patients with MS were extracted from a major national pharmacy benefit management company's databases for this retrospective cohort study. Enrollees with continuous medical and pharmacy benefits were followed for 3 years. MS relapse status was defined by a specific algorithm and was compared in patients who had specialty pharmacy care and those with usual community pharmacy care. The outcome measures included time to the first and second disease relapses and the number of relapses. Kaplan-Meier method and Cox proportional hazards regression analyses were performed on the time to first and second relapses, and generalized linear regression models were performed on the number of disease relapses.

Results: The study cohort included 1731 eligible patients with MS, of whom 1427 received specialty pharmacy care. During the study period, between 2006 and 2009, 1634 relapses were identified, with a mean annual relapse rate of 0.3 among the specialty pharmacy care group versus 0.4 among the usual pharmacy care group. Specialty pharmacy care was associated with a lower risk for disease relapse, with a hazard ratio (HR) of 0.73 (95% confidence interval [CI], 0.607-0.871) for the first relapse and HR of 0.78 (95% CI, 0.610-1.002) for the second relapse. When controlling for demographics, comorbidities, and index medications, specialty pharmacy care was associated with a lower risk for disease relapse with HR of 0.82 (95% CI, 0.680-0.985) for first relapse versus usual pharmacy care. The time to second relapse was not significantly different between the 2 groups in the unadjusted and adjusted Cox regression models. In addition, a generalized linear regression model showed that specialty pharmacy care, index age, geographic North region, 3-year Chronic Disease Score, and Elixhauser comorbidity measure were significantly associated with the number of disease relapses.

Conclusion: These results show that specialty pharmacy care is associated with a significantly lower risk for disease relapse in patients with MS (specifically the first relapse) and fewer relapses compared with usual community pharmacy care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394553PMC
November 2016

Examining the relationship between antihypertensive medication satisfaction and adherence in older patients.

Res Social Adm Pharm 2017 May - Jun;13(3):602-613. Epub 2016 Jul 9.

Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.

Background: The relationship between medication adherence and treatment satisfaction has been consistently positive, however, this relationship has not been examined among older adults with hypertension.

Objectives: The aim of this study was to examine the relationship between medication adherence and treatment satisfaction among a sample of older adults with hypertension.

Methods: This was a survey-based cross-sectional study in which seven community senior centers in the city of Memphis, Tennessee and its surrounding areas were visited. Individuals aged 60 years and older with self-reported hypertension who visited the community senior centers between August and December 2013 were asked to participate. The participants' satisfaction with their antihypertensive medications was assessed using a newly developed scale. The Short Form Health Survey (SF-12v2) was used to assess the health-related quality of life (HRQoL). The Primary Care Assessment Survey (PCAS) Communication scale was used to assess the satisfaction with health care provider communication. The Beliefs About Medicines Questionnaire (BMQ-General) was used to assess the participant beliefs about medications. The eight-item Morisky Medication Adherence Scale (MMAS-8) was used to assess adherence to antihypertensive medications. And the Single Item Literacy Screener (SILS) was used to assess health literacy. Multiple linear regression was conducted to examine the relationship between medication adherence and satisfaction with antihypertensive therapy controlling for multiple variables.

Results: One hundred and ninety participants with hypertension were included in the study. Most participants were white, women, aged ≥70 years, taking ≥2 prescription medications and having ≥2 medical conditions. After adjusting for age, education, number of prescription medications, race, health literacy, sex, marital status, SF-12v2 Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12), and PCAS-Communication scores, the overall satisfaction score of the antihypertensive medication regimen was positively and significantly associated with MMAS-8 sore (β = 0.262; 95% confidence interval, 0.007-0.517; P = 0.043).

Conclusions: Treatment satisfaction was associated with higher medication adherence among older adults with hypertension.
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http://dx.doi.org/10.1016/j.sapharm.2016.06.013DOI Listing
October 2017

Health Care Applicability of a Patient-Centric Web Portal for Patients' Medication Experience.

J Med Internet Res 2016 07 22;18(7):e202. Epub 2016 Jul 22.

College of Pharmacy, Seoul National University, Seoul, Republic Of Korea.

Background: With the advent of the patient-centered care paradigm, it is important to examine what patients' reports of medication experience (PROME) mean to patient care. PROME available through a Web portal provide information on medication treatment options and outcomes from the patient's perspective. Patients who find certain PROME compelling are likely to mention them at their physician visit, triggering a discussion between the patient and the physician. However, no studies have examined PROME's potential applicability to patient care.

Objective: This study aimed to examine older (≥50 years) adults' perceptions of the health care applicability of a hypothetical PROME Web portal. Specifically, this study investigated whether PROME would facilitate patient-physician communication, and identified the preferred reporting items and the trusted sponsors of such a PROME Web portal.

Methods: We used a cross-sectional, self-administered, 5-point Likert scale survey to examine participants' perceptions of a hypothetical PROME Web portal that compared PROME for 5 common antihypertensive medications. Between August and December 2013, we recruited 300 members of 7 seniors' centers in a metropolitan area of a southeastern state of the United States to participate in the survey.

Results: An overwhelming majority of study participants (243/300, 81.0%) had a favorable perception of PROME's health care applicability. They were mostly positive that PROME would facilitate patient-physician communication, except for the perception that physicians would be upset by the mention of PROME (n=133, 44.3%). Further, 85.7% (n=257) of participants considered the PROME information trustworthy, and 72.0% (n=216) were willing to participate by reporting their own medication experiences. Study participants wanted the PROME Web portal to report the number of reviews, star ratings, and individual comments concerning different medication attributes such as side effects (224/809, 27.7%), cost (168/809, 20.8%), and effectiveness (153/809, 18.9%). Finally, the PROME Web portal sponsorship was important to participants, with the most trusted sponsor being academic institutions (120/400, 30.0%).

Conclusions: PROME, if well compiled through Web portals, have the potential to facilitate patient-physician communication.
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http://dx.doi.org/10.2196/jmir.5813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994927PMC
July 2016

Exploring the factors that influence medication rating Web sites value to older adults: A cross-sectional study.

Geriatr Nurs 2016 Jan-Feb;37(1):36-43. Epub 2015 Nov 10.

Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.

In this cross-sectional study, we evaluated factors that affected the perceived value of medication rating Web sites to 284 people aged ≥ 60 years who were taking prescription medications. The Patient Reviews of Medication Experience (PROMEX) questionnaire score, which assessed participant opinions about the value of online reviews of medications, was positively associated with preference to share health care decision making with the health care provider and negatively associated with the Physical Component Summary (PCS-12) and Mental Component Summary scores of the Short Form 12 health survey. The Primary Care Assessment Survey Communication score, which measured participant satisfaction with the communication from the health care provider, was positively associated with PCS-12 and health literacy. In summary, older adults who had poor physical and mental health-related quality of life were more likely to believe that medication rating Web sites were useful and helpful in facilitating communication with health care providers.
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http://dx.doi.org/10.1016/j.gerinurse.2015.10.011DOI Listing
February 2017

Computer Activities for Persons With Dementia.

Gerontologist 2015 Jun;55 Suppl 1:S40-9

College of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee.

Purpose Of The Study: The study examined participant's experience and individual characteristics during a 7-week computer activity program for persons with dementia.

Design And Methods: The descriptive study with mixed methods design collected 612 observational logs of computer sessions from 27 study participants, including individual interviews before and after the program. Quantitative data analysis included descriptive statistics, correlational coefficients, t-test, and chi-square. Content analysis was used to analyze qualitative data.

Results: Each participant averaged 23 sessions and 591min for 7 weeks. Computer activities included slide shows with music, games, internet use, and emailing. On average, they had a high score of intensity in engagement per session. Women attended significantly more sessions than men. Higher education level was associated with a higher number of different activities used per session and more time spent on online games. Older participants felt more tired. Feeling tired was significantly correlated with a higher number of weeks with only one session attendance per week. More anticholinergic medications taken by participants were significantly associated with a higher percentage of sessions with disengagement. The findings were significant at p < .05. Qualitative content analysis indicated tailoring computer activities appropriate to individual's needs and functioning is critical. All participants needed technical assistance.

Implications: A framework for tailoring computer activities may provide guidance on developing and maintaining treatment fidelity of tailored computer activity interventions among persons with dementia. Practice guidelines and education protocols may assist caregivers and service providers to integrate computer activities into homes and aging services settings.
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http://dx.doi.org/10.1093/geront/gnv003DOI Listing
June 2015

Activity Engagement: Perspectives from Nursing Home Residents with Dementia.

Educ Gerontol 2015 Mar;41(3):182-192

Associate Professor, College of Pharmacy, The University of Tennessee Health Science Center, 881 Madison Ave. Memphis, TN 38163.

Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending in church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed.
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http://dx.doi.org/10.1080/03601277.2014.937217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256713PMC
March 2015

Preferred computer activities among individuals with dementia: a pilot study.

J Gerontol Nurs 2015 Mar 7;41(3):50-7. Epub 2014 Nov 7.

Computers offer new activities that are easily accessible, cognitively stimulating, and enjoyable for individuals with dementia. The current descriptive study examined preferred computer activities among nursing home residents with different severity levels of dementia. A secondary data analysis was conducted using activity observation logs from 15 study participants with dementia (severe = 115 logs, moderate = 234 logs, and mild = 124 logs) who participated in a computer activity program. Significant differences existed in preferred computer activities among groups with different severity levels of dementia. Participants with severe dementia spent significantly more time watching slide shows with music than those with both mild and moderate dementia (F [2,12] = 9.72, p = 0.003). Preference in playing games also differed significantly across the three groups. It is critical to consider individuals' interests and functional abilities when computer activities are provided for individuals with dementia. A practice guideline for tailoring computer activities is detailed.
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http://dx.doi.org/10.3928/00989134-20141029-01DOI Listing
March 2015

Uptake of generic drug discount program among vulnerable populations.

JAMA Intern Med 2014 Nov;174(11):1858-60

College of Nursing, University of Memphis, Memphis, Tennessee.

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http://dx.doi.org/10.1001/jamainternmed.2014.4497DOI Listing
November 2014

Do depressed patients on adjunctive atypical antipsychotics demonstrate a better quality of life compared to those on antidepressants only? A comparative cross-sectional study of a nationally representative sample of the US population.

Res Social Adm Pharm 2015 Mar-Apr;11(2):228-40. Epub 2014 Jun 13.

Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.

Background: The adjunctive use of some atypical antipsychotics (AAPs) has been popular for patients with treatment-resistant depression. However, little is known about the impact of these agents on patients' Health-related quality of life (HRQoL).

Objectives: The objective of this study is to examine the impact of the adjunctive AAPs use on HRQoL among users of antidepressants with self-reported depression.

Methods: Patients with depression (ICD-9-CM: 296, 300, and 311), and to have used the given AAPs and/or antidepressants for at least a year, were identified in the Medical Expenditure Panel Survey of 2008-2011. The patients were classified into users of adjunctive AAPs (i.e., antidepressants plus AAPs) and users of antidepressants only. Adjusted multivariate linear regression analyses were conducted to examine the association between the utilization of AAPs and HRQoL measure.(c)

Results: A total of 3638 participants who met the inclusion criteria were identified (306 on AAPs vs. 3332 on antidepressants only). The study subjects were ≥18 years, predominately White (91.9%) and female (71%). The AAPs utilization was not associated with higher scores in the Physical Component Summary (PCS-12) of the Short Form Health Survey (SF-12v2) (β = 1.542, 95% CI = -0.0142 to 3.0977, P = 0.0521). Rather, it was negatively associated with the Mental Component Summary (MCS-12) scores of the SF-12v2 (β = -1.5537, 95% CI = -3.0247 to -0.0827, P = 0.0385).

Conclusions: The utilization of AAPs was not associated with higher scores of HRQoL. The findings of this study should underscore the need to consider other treatment options as add-on therapy for depression before resorting to AAPs.
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http://dx.doi.org/10.1016/j.sapharm.2014.06.001DOI Listing
November 2015

Face-name memory in Alzheimer's disease.

Geriatr Nurs 2014 Jul-Aug;35(4):290-4. Epub 2014 Apr 17.

The University of Tennessee Health Science Center, 881 Madison Ave., Memphis, TN 38163, USA.

Alzheimer's disease (AD) affects face-name memory, the ability to recognize faces and recall names. Remembering face and name requires a sophisticated cognitive process because of the complexity and similarity among faces and also because of their arbitrary association with names. Assessments of face-name memory can measure episodic and semantic memory performance and are useful for early detection of AD. Improving face-name memory is possible through cognitive interventions targeted to promote procedural memory, which is often preserved until the late stage of AD. This article describes a conceptual model, assessment tools, and strategies for improving face-name memory in persons with AD.
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http://dx.doi.org/10.1016/j.gerinurse.2014.03.004DOI Listing
July 2016

Racial and ethnic disparities in influenza vaccinations among community pharmacy patients and non-community pharmacy respondents.

Res Social Adm Pharm 2014 Jan-Feb;10(1):126-40. Epub 2013 May 23.

Health Outcomes and Policy Research, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA. Electronic address:

Background: Since 2009, pharmacists in all 50 states in the U.S. have been authorized to administer vaccinations.

Objectives: This study examined racial and ethnic disparities in the reported receipt of influenza vaccinations within the past year among noninstitutionalized community pharmacy patients and non-community pharmacy respondents.

Methods: The 2009 Medical Expenditure Panel Survey was analyzed. The sample consisted of respondents aged 50 years or older, as per the 2009 recommendations by the Advisory Committee on Immunization Practices. Bivariate and multivariate logistic regression analyses were conducted to examine the influenza vaccination rates and disparities in receiving influenza vaccinations within past year between non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks) and Hispanics. The influenza vaccination rates between community pharmacy patients and non-community pharmacy respondents were also examined.

Results: Bivariate analyses found that among the community pharmacy patients, a greater proportion of Whites reported receiving influenza vaccinations compared to Blacks (60.9% vs. 49.1%; P < 0.0001) and Hispanics (60.9% vs. 51.7%; P < 0.0001). Among non-community pharmacy respondents, differences also were observed in reported influenza vaccination rates among Whites compared to Blacks (41.0% vs. 24.3%; P < 0.0001) and Hispanics (41.0% vs. 26.0%; P < 0.0001). Adjusted logistic regression analyses found significant racial disparities between Blacks and Whites in receiving influenza vaccinations within the past year among both community pharmacy patients (odds ratio [OR]: 0.81; 95% CI: 0.69-0.95) and non-community pharmacy respondents (OR: 0.66; 95% CI: 0.46-0.94). Sociodemographic characteristics and health status accounted for the disparities between Hispanics and Whites. Overall, community pharmacy patients reported higher influenza vaccination rates compared to non-community pharmacy respondents (59.0% vs. 37.2%; P < 0.0001).

Conclusion: Although influenza vaccination rates were higher among community pharmacy patients, there were racial disparities in receiving influenza vaccinations among both community pharmacy patients and non-community pharmacy respondents. Increased emphasis on educational campaigns among pharmacists and their patients, especially minorities, may be needed.
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http://dx.doi.org/10.1016/j.sapharm.2013.04.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858597PMC
August 2014

Dynamic view on affordability of fixed-dose combination antihypertensive drug therapy.

Am J Hypertens 2013 Jul 18;26(7):879-87. Epub 2013 Mar 18.

College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

Background: The use of fixed-dose combinations (FDCs) has been increasing since the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended using ≥2 drugs as the first-line drug therapy for patients with stage 2 hypertension. FDCs simplify the drug therapy regimen and reportedly lower the drug therapy cost compared with the free combination (FC) of 2 single-agent drugs. This study hypothesized that the affordability of FDCs over FCs would change over time depending on the availability of generic single-agent drugs.

Methods: This study used the 2009 Medical Expenditure Panel Survey. Antihypertensive drugs were identified based on the Food and Drug Administration national drug directory. Based on the 2 databases, regression models were run to predict average monthly drug cost as well as out-of-pocket cost for each prescription along with their 95% confidence intervals (CIs).

Results: Overall, FDCs (n = 26) had average monthly drug costs similar to respective FCs when FCs were not generically available. However, when FCs were generically available, FDCs (n = 11) had average drugs costs much higher than their respective FCs. For example, Lotrel as an FDC had an average monthly drug cost of $115.97 (95% CI = $96.59-$135.36), whereas its counterpart FC had an average monthly drug cost of $21.00 (95% CI = $18.23-$23.79).

Conclusions: The cost advantage of FDCs over FCs was reversed when FCs were generically available. The finding of this study informs patients, health-care providers, and drug plans of the importance of making dynamic decisions on preferred drug therapy options depending on the availability of generic drugs.
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http://dx.doi.org/10.1093/ajh/hpt035DOI Listing
July 2013

A patient-centric goal in time to blood pressure control from drug therapy initiation.

Clin Transl Sci 2013 Feb 14;6(1):7-12. Epub 2013 Jan 14.

University of Tennessee Health Science Center, College of Pharmacy, Memphis, TN, USA.

A time frame in which newly diagnosed hypertensive patients attain blood pressure (BP) goal would guide patients through uncertainty associated with initiating drug therapy for hypertension control. This study estimates time to BP goal resulting from drug therapy initiation among real-world hypertensive patients and identifies factors associated with variations in time to BP goal. The study uses a historical cohort design. Hypertensive patients who had initiated antihypertensive drug therapy between July 1, 2002, and December 31, 2003, were followed up to 12 months until the end of 2004. Electronic medical records from a medical group were linked with pharmacy claims, as well as with medical claims. Survival analyses were used to compare lengths of time needed to reach BP goals. A total of 223 patients from a real world practice setting had initiated antihypertensive drug therapy. The patients took 3.25 months (95% CI: 2.49-4.82) to reach BP goal. The patient-centric time to BP goal was 7.1 weeks longer than those reported in controlled experimental settings. This finding highlights the gap between results of controlled clinical trials and their application to clinical practice, and informs healthcare practitioners of the importance of setting a patient-centric goal in pharmacological treatment of hypertension.
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http://dx.doi.org/10.1111/cts.12021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414534PMC
February 2013

Feasibility of providing computer activities for nursing home residents with dementia.

Nonpharmacol Ther Dement 2013 ;3(1):1-10

College of Pharmacy, The University of Tennessee Health Science Center, 881 Madison Ave. Memphis, TN 38163, ; ,

Introduction: Nursing home residents with dementia need cognitively stimulating and enjoyable activities, and computer technology offers them a means of engaging in such activities. This study therefore examined the feasibility of providing a 12-week computer activity program (CAP) for nursing homes residents with dementia.

Methods: Fourteen participants completed the CAP, and 462 observational logs of CAP sessions were analyzed.

Results: On average, participants completed 33 sessions amounting to 936.5 minutes over 12 weeks. Participants with mild and moderate dementia preferred playing a cognitively challenging game such as solitaire, while those with severe dementia enjoyed watching slideshows with music.

Conclusion: The findings suggest that it is important to match computer activities to interests and cognitive ability in order to increase participation and satisfaction of NH residents with dementia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204016PMC
January 2013

Racial and ethnic disparities in meeting Part D MTM eligibility criteria among the non-Medicare population.

J Am Pharm Assoc (2003) 2012 Sep-Oct;52(5):e87-96

College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave., Memphis, TN 38163, USA.

OBJECTIVE To determine whether racial and ethnic minorities were less likely to meet the Medicare Part D eligibility criteria for medication therapy management (MTM) services compared with whites among the adult non-Medicare population, because some non-Medicare health plans have followed the Medicare example. DESIGN Cross-sectional observational study. SETTING United States, 2007-08. PATIENTS 16,691 white, 5,923 black, and 9,242 Hispanic adults (>17 years) among the non-Medicare population. INTERVENTION Analysis of the Medical Expenditure Panel Survey. MTM eligibility criteria used by Part D plans in 2008 and 2010-11 were examined. Main and sensitivity analyses were conducted to represent the entire range of the eligibility thresholds used by Part D plans. Analyses also were conducted among individuals with heart disease, diabetes, and hypertension. MAIN OUTCOME MEASURES Proportions and odds of patients meeting Part D MTM eligibility criteria. RESULTS According to the main analysis examining 2008 eligibility criteria, whites had a higher proportion of eligible individuals than did blacks (3.73% vs. 2.57%) and Hispanics (1.53%, P < 0.05 for both comparisons). According to survey-weighted logistic regression adjusting for patient characteristics, blacks and Hispanics had odds ratios for MTM eligibility of 0.60 (95% CI 0.46-0.79) and 0.54 (0.40-0.72), respectively, compared with whites. Sensitivity analyses, analyses examining 2010-11 eligibility criteria, and analyses among individuals with heart disease, diabetes, and hypertension produced similar findings. CONCLUSION Racial and ethnic minorities have lower odds for meeting Part D MTM eligibility criteria than whites among the adult non-Medicare population. MTM eligibility criteria need to be modified to address these disparities.
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http://dx.doi.org/10.1331/JAPhA.2012.11146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535494PMC
February 2013

The impact of patient knowledge of patient-centered medication label content on quality of life among older adults.

Res Social Adm Pharm 2013 Jan-Feb;9(1):37-48. Epub 2012 May 2.

Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Suite 219, Memphis, TN 38163, USA.

Background: Prescription drugs have made great contributions to health and quality of life (QOL). However, inappropriate use of drugs may result in just the opposite effect. Older adults often take multiple medications simultaneously and thus are more vulnerable to inappropriate drug use. Knowledge of important aspects of medication use might reduce the risk of inappropriate utilization and improve QOL.

Objective: To determine the extent of patient knowledge concerning patient-centered contents of medication labels (PCCMLs) and whether level of patient knowledge is associated with health outcomes.

Methods: A survey was administered to members of 6 senior centers in Memphis, TN, USA. Surveys from older adults (65 or older) who were taking at least 1 medication were included in the current analyses (N=287). QOL was measured using the Euroqual EQ-5D and the Visual Analog Scale (EQ-VAS). Older adults reported their knowledge of PCCML on a set of 4 Likert-type scale items concerning the PCCMLs. Statistical analyses included descriptive statistics, analysis of variance, correlation analysis, and linear regression.

Results: Study participants scored on average 16.20 (standard deviation [SD]=3.41) for knowledge of PCCML. Patient knowledge of PCCML was associated with age (r(s)=-0.1469, P=.0127), race/ethnicity (F=4.40, P=.0131), education (r(s)=0.1984, P=.0007), and household income (r(s)=0.1539, P=.0159). Study participants had an average EQ-5D score of 0.82 (SD=0.16) and EQ-VAS score of 77.80 (SD=15.07). Multivariate linear regression results showed that 1 unit increase in patient knowledge resulted in 0.62 unit increase (P=.017) in EQ-VAS QOL scores after adjusting for the impact of other variables. However, patient knowledge of PCCML did not significantly predict EQ-5D QOL scores (β^=0.002, P=.4633) when all other variables were controlled.

Conclusion: Patient knowledge of medication use was associated with QOL among older adults. New standardized labels should be designed to improve patient knowledge of PCCML information. Furthermore, providers of medication therapy management should ensure that older adults have a complete knowledge of the PCCML information.
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http://dx.doi.org/10.1016/j.sapharm.2012.02.004DOI Listing
May 2013

Contingent valuation and pharmacists' acceptable levels of compensation for medication therapy management services.

Res Social Adm Pharm 2015 May-Jun;11(3):e121-32. Epub 2012 Mar 20.

College of Pharmacy, University of Tennessee Health Science Center, Department of Pharmaceutical Sciences, Division of Health Outcomes and Policy Research, 881 Madison Avenue, Room 221, Memphis, TN 38163, USA.

Background: Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques.

Objectives: Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services.

Methods: A mailing survey was used to elicit Tennessee (U.S.) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness to accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA.

Results: Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates.

Conclusions: Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15-$50 and patients' willingness to pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services.
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http://dx.doi.org/10.1016/j.sapharm.2012.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445666PMC
January 2016

Conjoint analysis of patient preferences on Medicare medication therapy management.

J Am Pharm Assoc (2003) 2011 May-Jun;51(3):378-87

College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA.

Objectives: To identify attributes of medication therapy management (MTM) valued by Medicare beneficiaries and to determine patient preferences and willingness to pay for MTM attributes.

Design: Cross-sectional contingency valuation study.

Setting: Six senior centers in Memphis, TN, from September 2007 through August 2008.

Participants: 355 Medicare beneficiaries.

Intervention: A discrete choice experiment was used, in which each study participant was asked to choose from two different hypothetical MTM services defined by seven attributes (service setting, provider type, number of drug therapy problems, provider experience in overall practice, provider experience in geriatrics, time spent, and cost of MTM service) and associated levels.

Main Outcome Measures: Patient preferences for different attributes of MTM services and patients' estimated marginal willingness to pay for each attribute level.

Results: Study participants viewed cost (relative importance 32.2%) as the most important attribute of MTM, followed by service setting (24.2%), provider experience in overall practice (19.5%), and provider experience in geriatrics (16.6%). Community pharmacies (β = 0.146, P = 0.007) were the most preferred environment for MTM services, followed by clinics, whereas telephone consultation was the least preferred environment (β = -0.349, P < 0.001). Study participants were willing to spend as much as $31.76 (95% CI 19.84-45.27) to trade telephone MTM for clinic-based MTM. They also were willing to pay $13.31 more (3.60-23.65) for MTM service at a community pharmacy compared with clinic-based MTM.

Conclusion: Health plans should consider developing community pharmacy-based MTM options, at least for Medicare beneficiaries without mobility limitations.
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http://dx.doi.org/10.1331/JAPhA.2011.10039DOI Listing
September 2011

Pharmacists' acceptable levels of compensation for MTM services: a conjoint analysis.

Res Social Adm Pharm 2011 Dec 5;7(4):383-95. Epub 2010 Nov 5.

Health Outcomes and Policy Research, Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, 847 Monroe Avenue, Memphis, TN 38163, USA.

Background: The Medicare Modernization Act of 2003 requires prescription drug plans to provide medication therapy management (MTM) services to Medicare beneficiaries who are at high risk for inappropriate use of medications. However, inadequate compensation has been a barrier for MTM expansion among pharmacists.

Objectives: The objective of this study was to determine pharmacists' acceptable levels of compensation for MTM services.

Methods: A preference-based fractional factorial design of conjoint analysis was used by surveying 1524 active pharmacists in Tennessee. Pharmacists were asked to select between packages (scenarios) of MTM services that represented combinations of MTM attributes (characteristics). The MTM attributes included type of patient (new or returning), patient's number of chronic conditions (1, 3, or 6), patient's number of medications (4, 8, or 16), patient's annual drug costs ($2000, $3000, or $4000), service duration (15 minutes, 30 minutes, or 45 minutes), and price of MTM services ($30, $60, or $120). A survival analysis model was used to predict pharmacists' willingness to select 1 versus another MTM service package. Pharmacists' acceptable level of compensation was estimated as the marginal rate of substitution between the parameter estimates of an attribute and the price attribute of MTM.

Results: The parameter estimates were -0.0303 (P<.0001) for service duration and 0.0210 (P<.0001) for price of MTM services, respectively, so pharmacists were willing to accept $1.44/min (0.0303/0.0210), or $86.4/h, for MTM services. Pharmacists' characteristics were associated significantly with their acceptable levels of compensation: years of practice was associated with a higher need for compensation, pharmacy ownership (vs nonowner) associated with a lower need, and having provided MTM previously (vs having not provided MTM) was associated with a higher need.

Conclusions: Pharmacists' acceptable level of compensation is in the higher part of current ranges from $30 to $100/h. To increase participation in MTM services, pharmacist compensation needs to be increased. Future studies might continue to corroborate the generalizability of findings from this study.
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http://dx.doi.org/10.1016/j.sapharm.2010.09.003DOI Listing
December 2011

Disparity implications of Medicare eligibility criteria for medication therapy management services.

Health Serv Res 2010 Aug 24;45(4):1061-82. Epub 2010 May 24.

Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, 847 Monroe Avenue, Room 205R, Memphis, TN 38163, USA.

Objective: To determine whether there would be racial and ethnic disparities in meeting eligibility criteria for medication therapy management (MTM) services implemented in 2006 for Medicare beneficiaries.

Data Sources/study Setting: Secondary data analyses of the Medical Expenditure Panel Survey (2004-2005).

Study Design: Logistic regression and recycled predictions were used to test the disparities in meeting eligibility criteria across racial and ethnic groups. The eligibility thresholds used by health plans in 2006 and new thresholds recommended for 2010 were examined. Racial and ethnic disparities were examined by comparing non-Hispanic blacks (blacks) with non-Hispanic whites (whites) and comparing Hispanics with whites, respectively. Disparities were also examined among individuals with severe health problems.

Principal Findings: According to 2006 thresholds, the adjusted odds ratios for meeting eligibility criteria for blacks and Hispanics to whites were 0.36-0.60 (p<.05) and 0.13-0.46 (p<.05), respectively. Blacks and Hispanics would be 21-34 and 32-38 percent, respectively, less likely to be eligible than whites according to recycled predictions. Similar patterns were found using the 2010 eligibility thresholds and among individuals with severe health problems.

Conclusions: There would be racial and ethnic disparities in meeting MTM eligibility criteria. Future research is warranted to confirm the findings using data after MTM implementation.
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http://dx.doi.org/10.1111/j.1475-6773.2010.01118.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910569PMC
August 2010

A comparison of direct medical costs across racial and ethnic groups among children with cancer.

Curr Med Res Opin 2008 Mar 6;24(3):847-58. Epub 2008 Feb 6.

Division of Health Outcomes and Policy Research, Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, Memphis, TN 38163, USA.

Objective: Previous studies reported that some minority childhood cancer patients are likely to develop worse outcomes than white children. This study examines whether there are racial and ethnic disparities in health expenditures among children with cancer.

Research Design And Methods: A retrospective study was conducted among children (younger than 20) with cancer diagnoses in the Medical Expenditure Panel Survey (MEPS; 1996 to 2004). Total health expenditures and the following subcategories were examined across racial and ethnic groups: (1) office-based visits; (2) outpatient visits; (3) inpatient and emergency room visits; (4) home health care; (5) prescription drugs; and (6) dental, vision, and other health care expenditures. Consumer price indexes were used to convert all expenditures to 2004 dollars. A classical linear model was analyzed using the natural logarithm of health expenditures as the dependent variable, with the purpose of determining whether there were racial and ethnic differences in health expenditures after adjusting for confounding factors.

Results: Study sample included 394 non-Hispanic whites (weighted to 4 958 685), 53 non-Hispanic blacks (weighted to 352 534), and 94 Hispanic whites (weighted to 424 319). Hispanic blacks and other minority populations were excluded from the analysis due to insufficient sample size. The annual total health expenditure for treating each child with cancer was $3467.40, $2156.15, and $5545.34, respectively, among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites. The differences in the various subcategories of health expenditures across racial and ethnic groups were generally not significant according to both descriptive and analytical analyses with very few exceptions.

Conclusions: This study did not identify significant racial and ethnic disparities in health care costs. However, one important study limitation is the small sample size of the minority populations in the study sample.
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http://dx.doi.org/10.1185/030079908X273390DOI Listing
March 2008

Patterns of reporting health-related quality of life across racial and ethnic groups.

Expert Rev Pharmacoecon Outcomes Res 2007 Apr;7(2):177-86

Assistant Professor, University of Tennessee College of Pharmacy, Division of Health Science Administration, Department of Pharmaceutical Sciences, 847 Monroe Ave., Room 205R, Memphis, TN 38163, USA.

The National Institute of Health and the US FDA have regulations on the inclusion of minorities in research, and guidelines on how to conduct and report subgroup analyses among each racial and ethnic group. Although health-related quality of life (HRQL) has enjoyed increased popularity as an important end point in clinical research, the literature lacks a comprehensive review on whether or not racial and ethnic groups report HRQL differently, particularly among patients with specific disease states. HRQL is different from most other end points in clinical research in that it is reported by patients and thus is affected by patients' racial and ethnic background in a special way. This paper summarizes the existing literature on patterns of reporting HRQL across racial and ethnic groups. It begins with a summary of general HRQL patterns and subsequently covers HRQL related to renal disease, breast cancer and prostate cancer. This paper is not intended to be exhaustive, but to inform researchers of good practice in clinical research utilizing HRQL as study end points.
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http://dx.doi.org/10.1586/14737167.7.2.177DOI Listing
April 2007

Daily stress in elders with arthritis.

Nurs Health Sci 2007 Mar;9(1):29-33

College of Nursing, Univeristy of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.

This study examined whether social support perceived by older people with arthritis mediated the experience of daily stress related to the physical disability of arthritis. Seventy participants completed survey questionnaires. The data were analyzed using the three-step regression analysis procedure. Daily stress was significantly correlated with physical disability and social support. Increased physical disability led to more daily stress. Also, arthritic patients with increased physical disability perceived lower levels of social support. Social support decreased the effects of physical disability on daily stress and had a significant effect on daily stress. However, social support did not fully mediate the effect of physical disability on daily stress. Caregivers should recognize that social support has a limited role in alleviating the daily stress that arthritic patients experience from physical disability. Studies are needed to develop and test stress management programs targeting various sources of daily stress.
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http://dx.doi.org/10.1111/j.1442-2018.2007.00301.xDOI Listing
March 2007

A 30-month evaluation of the effects on the cost and utilization of proton pump inhibitors from adding omeprazole OTC to drug benefit coverage in a state employee health plan.

J Manag Care Pharm 2006 Jan-Feb;12(1):25-32

Division of Pharmarceutical Evaluation, University of Arkansas for Medical Sciences-College of Pharmacy, Little Rock, AR 72205-7199, USA.

Objective: On March 1, 2004, the state employee health plan began covering omeprazole OTC (over the counter) at a $5 copayment. Reimbursement to pharmacy providers for omeprazole OTC increased by $10.50 per claim, from $2.50 to a $13 dispensing fee. Initially, neither generic omeprazole prescription (Rx) nor brand omeprazole Rx was covered because omeprazole OTC was available in the same strength as the Rx products at a lower cost, but an omeprazole OTC shortage necessitated coverage of generic omeprazole Rx at a $10 copay. The objective of this study was to evaluate the long-term financial impact of a drug benefit policy change on a mid-size state employee health plan and its beneficiaries associated with the addition to coverage of omeprazole OTC.

Methods: The pharmacy claims database for the employee benefits division (EBD) was used to examine utilization and cost data for beneficiaries who received proton pump inhibitors (PPIs). Pharmacy claims for the 30-month period for dates of service from December 1, 2002, through May 31, 2005, were extracted from the database, yielding a preperiod of 15 months and a postpolicy change period of 15 months.

Results: In the 15-month postperiod, the number of PPI claims per member per month (PMPM) decreased by 3.9%, but the days of PPI therapy PMPM increased from 1.71 to 1.82 (6.4%). Price as measured by the allowed charge per day of drug therapy decreased from $4.25 to $2.74 (35.6%) despite an increase of $1.89 (76%) in the average dispensing paid per PPI claim to pharmacies, from $2.49 to $4.38. The average beneficiary copayment decreased by $0.50 (2.0%) per PPI claim, from $25.06 in the preperiod to $24.56 per claim in the postperiod. Therefore, the net heath plan cost for PPIs decreased by $2.20 PMPM (37.6%) during the 15-month postperiod, from $5.84 to $3.64 PMPM, producing savings of $4,207,350, or annualized savings of $3,365,880, in this employee benefit plan of 127,495 members.

Conclusion: A change in policy to include coverage of omeprazole OTC and an increase in pharmacy reimbursement for omeprazole OTC resulted in 38% net savings to a state employee health plan. The large difference in drug acquisition cost between omeprazole OTC and the other Rx-only PPIs made it possible to implement a program intervention that provided financial benefit to pharmacists, beneficiaries, and the drug plan sponsor despite a 6% increase in PPI utilization.
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http://dx.doi.org/10.18553/jmcp.2006.12.1.25DOI Listing
May 2006

Inappropriate use of inhaled short acting beta-agonists and its association with patient health status.

Curr Med Res Opin 2006 Jan;22(1):33-40

Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR 72223, USA.

Background: Despite the widespread distribution of guidelines on the proper use of inhaled asthma medication, the overuse of short acting bronchodilators (SABs) persists. This study aims to examine how inhaled asthma medications are used in the US and to examine whether inappropriate use of inhaled SABs is associated with poor patient health.

Research Design And Methods: The study design was a retrospective analysis of the Medical Expenditure Panel Survey (MEPS) for asthmatic patients 5 years or older who had used SAB medication during the period from 1996 through 2000. Use of SAB medication was defined as inappropriate when a patient inhaled more than 225 defined daily doses (DDDs) of SABs but less than 45.625 DDDs of corticosteroids per year. Health status was evaluated using survey respondents' perceptions on a 5-point Likert scale. Five functional limitations (activities of daily living, instrumental activities of daily living, walking, social function, and cognitive function) were rated on a dichotomous scale.

Results: A total of 2386 asthmatic patients were identified as having used a SAB in the period 1996 through 2000. Of these, 272 (11.4%) used excessive doses of SABs, and of this group of excessive users, 151 (55.5%) underused corticosteroids. Compared to appropriate users of SAB medication, inappropriate users had lower perceptions of their overall health (adjusted mean: 3.21 vs. 2.94, p<0.05) and mental health (adjusted mean: 2.39 vs. 2.13, p<0.05). They were also at an increased risk of limitations in walking (relative risk [RR]: 1.76, 95% confidence interval [CI]:1.15-2.71) and in cognitive function (RR: 2.32, 95% CI: 1.37-3.93).

Conclusion: Despite the national guidelines concerning the proper use of inhaled asthma medication, over-reliance on SAB medication and under-use of corticosteroids persists in the US. Those not using asthma medication according to the guidelines had poor perceptions of their health and were subject to an increased risk of limitations in walking and cognitive function.
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http://dx.doi.org/10.1185/030079905X74934DOI Listing
January 2006
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