A national survey of U.S. pharmacists in 2000: assessing nonresponse bias of a survey methodology

The first objective of this study was to assess the existence of nonresponse bias to a national survey of licensed pharmacists conducted in 2000. Three methods were used to assess nonresponse bias. The second objective of the study was to examine reasons why sampled licensed pharmacists did not respond to the national survey of licensed pharmacists. We used data from 2204 respondents to a national survey of pharmacists and from 521 respondents to a survey of nonrespondents to the national survey. We made comparisons between respondents for 5 variables: employment status, gender, age, highest academic degree, and year of initial licensure. Chi-square tests were used to examine differences in the 5 variables between respondents to the first mailing and second mailing of the survey, early and late respondents to the survey, and respondents to the survey and respondents to the nonrespondent survey. There were no significant differences between first mailing and second mailing respondents, but there were differences in each variable except year of licensure between early and late respondents. These differences likely were due to regional bias possibly related to differences in mailing times. There were differences between respondents and nonrespondents in terms of employment status and year of licensure. The main reasons for not responding to the survey were that it was too long or that it was too intrusive. Overall, the survey methodology resulted in a valid sample of licensed pharmacists. Nonresponse bias should be assessed by surveying nonrespondents. Future surveys of pharmacists should consider the length of the survey and the address where it is sent.

Periodontal plastic surgical technique for gingival fenestration closure

Gingival fenestration is an opening through oral keratinized tissue, usually unattached, that is observed in thin gingiva with usually thick subgingival calculus deposits. This lesion is seen infrequently but may be more common than has been reported; lack of symptoms may inhibit patient awareness. Because surgical correction usually is not required, there are very few reports in the literature concerning this lesion. The following report describes a case of gingival fenestration and surgical treatment with a connective tissue/periosteal graft.

Use of labor economic theory to examine hours worked by male and female pharmacists

PURPOSE

The objectives of this study were to develop a theoretically derived model of hours worked by pharmacists and estimate the model separately for male and female pharmacists.

METHODS

A systematic random sample of 1,600 pharmacists from four states was mailed a survey asking about current and past employment information. Two dependent variables were studied: weekly hours worked and annual hours worked. Independent variables were categorized as economic variables (hourly wage rate, other income, total debt) and demographic variables (employment position, age, degree earned, marital status, number of children at home). A two equation multiple regression model was estimated with two-stage least squares regression.

RESULTS

A total of 541 pharmacists responded to the survey and data from 442 of the respondents were used in the analysis. Hourly wage rates were negatively associated with weekly hours worked for males. Other income and total debt were significantly negatively and positively associated, respectively, with annual hours worked by female pharmacists. The number of young children at home significantly reduced weekly and annual hours worked by female pharmacists. Female pharmacists earning a Pharm.D. degree worked significantly more hours weekly and annually. Age was significantly negatively associated with male pharmacists weekly and annual hours worked.

CONCLUSIONS

Economic variables had a relatively small effect on hours worked by male and female pharmacists suggesting that increased wage rates may not increase hours worked. Strategies to increase hours worked by females likely should focus on benefits to help females handle childcare issues.

Treatment of gingival recession with collagen membranes

Periodontal plastic surgical techniques to obtain root coverage traditionally have utilized autogenous soft tissue grafts. Guided tissue regeneration (GTR) increasingly is being used as an alternative to soft tissue grafting in attempting root coverage. Resorbable membranes in GTR therapy prevent the need for a second surgery to harvest donor tissue. GTR membranes composed of collagen are effective barriers that add to the thickness of the overlying gingiva and possess platelet-aggregating properties that may help in early wound healing. The cases presented here demonstrate the treatment of gingival recession with a resorbable collagen membrane.

Job matching in pharmacy labor markets: a study in four states

PURPOSE

Reports from various pharmacy labor market sectors suggest that the United States may be experiencing a shortage of pharmacists. To guide policy making and planning with respect to this shortage, it is necessary to develop a better understanding of the process by which pharmacists choose jobs. Using the economic theory of job matching, this study sought to understand how (a) attributes of the practice setting, (b) characteristics of pharmacists, and (c) regional and urbanization variables are associated with pharmacy practice setting choices.

METHODS

A secondary database containing information about employment characteristics and work histories of 541 pharmacists in four states was used. The data were augmented with information on the relative number of employment opportunities in each of three practice settings (large chain, institutional, and independent) in the year the respondent's most recent employment change occurred. Practice setting choices were modeled using multinomial conditional logit regression.

RESULTS

A total of 477 pharmacists represented in the database met the inclusion criteria for the study. Multivariate analyses showed that the impact of search costs and wage differentials varied with the practice setting chosen. Pharmacists choosing independent settings over large chain settings were more likely to be white and to have worked in an independent setting in their prior job. Pharmacists living in Oregon were less likely to choose institutional settings compared to those living in Massachusetts, whereas those living in areas with populations greater than 50,000 were more likely to choose institutional settings.

CONCLUSIONS

Pharmacist job matching appears to be a complex process in which diverse factors interact to produce a final match. Our results suggest that the pharmacy labor market may actually be composed of two distinct labor markets: an ambulatory market and an institutional market.

Pharmacist job turnover, length of service, and reasons for leaving, 1983-1997

Pharmacist job turnover from 1983 to 1997 was studied. Data were collected from a randomized 1997 mail survey of 1600 licensed pharmacists in four states (Ohio, Massachusetts, Oregon, and Alabama). The survey instrument included questions on pharmacist demographics, work schedules, salary, and work history. A total of 541 pharmacists responded, yielding an adjusted response rate of 34.5%. Information was provided on a total of 1697 jobs with start dates from 1931 to 1997. Pharmacist job turnover was fairly steady across the 1983-1997 period, averaging 11% annually. The average median tenure of pharmacists who left jobs was 32 months. The percentage of pharmacists leaving jobs and ranking stress as the reason for leaving increased, and the percentage of leavers ranking salary as the reason decreased. Women had a significantly higher annual turnover rate (15%) than men (9.7%), and they stayed in jobs for significantly less time (25.2 months) than men (56.5 months). There were no differences in turnover rates across practice settings. A larger percentage of pharmacists leaving jobs in large chain and institutional settings ranked stress as a reason for leaving than pharmacists leaving independent or small chain pharmacies. A larger percentage of pharmacists leaving independent or small chain pharmacies ranked salary as a reason than pharmacists in the other two settings. Pharmacist job turnover averaged 11% per year between 1983 and 1997. Pharmacists who left jobs typically stayed less than three years. The percentage citing stress as a reason for leaving increased, and the percentage citing salary decreased.

Evaluating prescriptions for the elderly: drug/age criteria as a tool to help community pharmacists

OBJECTIVES

To use drug/age criteria to determine (1) the prevalence of dispensing of drugs potentially inappropriate for use in elderly patients; (2) the dispensing rate of individual drugs considered potentially inappropriate for use in elderly patients; (3) the association between selected patient characteristics and the prevalence of potentially inappropriate drug dispensing.

DESIGN, SETTING, PARTICIPANTS

A secondary database of 6,380 new prescription orders dispensed to patients of all ages in ambulatory pharmacies in a mid-western state was used retrospectively for the analysis. A total of 1,530 (23.9%) of the new prescription orders were dispensed to 1,185 elderly patients.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Name, strength, and daily dose of each drug dispensed were compared with drug/age criteria to determine whether a dispensed drug was inappropriate for use in elderly patients. The association of the rate of dispensing of potentially inappropriate drugs with characteristics of the elderly patients, including age, sex, race, number of comorbidities, and prescription drug insurance coverage type, was determined.

RESULTS

A total of 170 patients (14.3%) were dispensed potentially inappropriate medications. The three most common medications were propoxyphene and propoxyphene combinations, prescription and nonprescription antihistamines, and digoxin at doses > 0.125 mg/day. There was no statistically significant association between inappropriate drug dispensing and patient age, sex, race, number of comorbidities, and prescription drug insurance coverage type.

CONCLUSION

Pharmacists can use drug/age criteria as a tool for an initial check to assess the appropriateness of drugs used by the elderly. Elderly patients appear equally at risk of using potentially inappropriate medications regardless of demographic, disease, or insurance characteristics.

Assessing the needs of pharmacists and physicians in caring for patients with epilepsy

OBJECTIVE

To obtain primary care physicians' and community pharmacists' opinions of the Pharmacist Note, a model epilepsy patient profile maintained by the pharmacist and transmitted to the physician as needed, and the information it contains.

DESIGN

A cross-sectional descriptive study design was used for collecting and analyzing data. Separate surveys were developed and mailed to physicians and pharmacists.

PARTICIPANTS

554 primary care physicians and 114 community pharmacists in Ohio who interact regularly with epilepsy patients.

MAIN OUTCOME MEASURES

Pharmacist and physician opinions on the Pharmacist Note program.

RESULTS

Physicians ranked seizure frequency as their most useful piece of information, followed by medication compliance and drug interaction screening. For medication profile and drug interaction screening, most physicians currently use themselves as their primary source of information, although a significant number would prefer to use pharmacists as information sources in these areas (p < .05). A majority (62%) would like to have pharmacists more involved in the care of their patients. Pharmacists identified lack of time and lack of appointments with patients, inadequate pharmacy staff, and insufficient reimbursement as barriers to implementing the Pharmacist Note program.

CONCLUSION

Physicians desire pharmacist involvement in specific areas of care for patients with epilepsy, and the feasibility of implementing the Pharmacist Note and similar programs appears promising. However, pharmacists identified barriers to implementation, and these barriers need to be addressed if this type of program is to be successful.

Attitudes of Ohio hospital pharmacy directors toward national voluntary pharmacy technician certification

Ohio pharmacy directors' attitudes about national voluntary pharmacy technician certification were surveyed. In May 1996 a questionnaire was mailed to all 224 hospitals in Ohio. The questionnaire contained 29 attitudinal statements constructed as forecasts of the effects of certification; pharmacy directors were asked to rate their level of agreement or disagreement with each statement using a 7-point Likert scale. The response rate was 61.4% (137 questionnaires returned). Respondents indicated modest agreement with 21 of 27 attitudinal statements and therefore had a generally positive view of certification. For example, they agreed that certification will improve technicians' knowledge, image, confidence, skills, and job satisfaction. They disagreed that certification will allow technicians to function independently, result in the replacement of pharmacist positions with technicians, or eliminate the need for on-the-job training of technicians. There were significant differences in scores between directors working at hospitals employing certified technicians and directors working at hospitals not employing certified technicians for only three statements. Overall, Ohio hospital pharmacy directors had positive attitudes about pharmacy technician certification.

The association of insurance type with costs of dispensed drugs

This study examines the association between types of prescription drug insurance coverage and the unit cost of dispensed drugs. Logistic regression and ordinary least squares regression were used to assess differences in the use of brand name and generic drugs and the unit cost of dispensed brand name or generic drugs across four insurance categories: Medicaid, private third party, indemnity, and uninsured. The results show that private third-party and indemnity prescriptions were more likely to be dispensed with brand name drugs. Also, indemnity patients and the uninsured were dispensed brand name and generic drugs with lower unit costs. The findings have ramifications for the design of prescription drug insurance benefits and suggest that physicians may respond to the economic situation of their patients when prescribing drugs.

Comparison of targeting a DUR letter intervention at pharmacists separate from and in addition to physicians

OBJECTIVE

To examine the impact on dipyridamole prescribing of a letter mailed to pharmacists and/or physicians.

DESIGN

Interrupted time series with control series.

SETTING

State of Wisconsin.

PARTICIPANTS

Physicians and pharmacists caring for patients who were prescribed dipyridamole.

INTERVENTIONS

The state of Wisconsin was divided into four sections, three of which were designated as experimental regions (letter to physician only, letter to pharmacist only, and letter to both physician and pharmacist) and one of which served as a control region.

MAIN OUTCOME MEASURES

Cost of drug per patient per month in ambulatory and long-term care populations.

RESULTS

For 763 long-term care and 586 ambulatory Medicaid patients, letters sent to both physicians and pharmacists resulted in significant reductions in dipyridamole expenditures relative to the control group. For long-term care patients, interventions directed at both physicians and pharmacists produced significant reductions in dipyridamole prescribing relative to interventions directed at physicians alone or pharmacists alone.

CONCLUSION

Future DUR letter interventions designed to change prescribing habits would be more effective if they targeted both physicians and pharmacists, particularly in the long-term care setting.

A controlled letter intervention to change prescribing behavior: results of a dual-targeted approach

OBJECTIVE

To determine the effectiveness of a drug utilization review (DUR) letter intervention sent only to physicians, sent only to pharmacists, or sent to both physicians and pharmacists in changing physician prescribing behavior for dipyridamole.

DATA SOURCES/STUDY SETTING

A Wisconsin Medicaid prescription drug database for data from March 1991 through May 1992 related to both long-term care and ambulatory patient settings.

STUDY DESIGN

The effects of a DUR letter intervention were tested using a field study, pre-post, nonequivalent control group, quasi-experimental design. The effects of the letter intervention in terms of dipyridamole expenditures (dollars reimbursed to pharmacies by Medicaid), expenditures for related drugs (aspirin, ticlopidine, sulfinpyrazone) and numbers of patients for whom dipyridamole was discontinued were examined across three experimental groups and a control group.

DATA COLLECTION/EXTRACTION METHODS

Dipyridamole expenditures for each study patient during a six-month preintervention and six-month postintervention period were collected from Medicaid prescription drug claims. Patients who had zero dipyridamole expenditures throughout the six-month postintervention period were classified as having had dipyridamole discontinued.

PRINCIPAL FINDINGS

Letters sent to both physicians and pharmacists resulted in a greater percentage of patients discontinuing dipyridamole relative to controls and statistically significant differences in postintervention dipyridamole expenditures relative to controls in both the long-term care and ambulatory patient populations.

CONCLUSIONS

Interventions that focus on another person in the drug use process in addition to the physician may have greater effects on a change in the prescribing of a targeted drug than letters to physicians alone.

An internal rate of return approach to investigate pharmacist supply in the United States

Internal rates of return were used to examine the status of pharmacist supply in the United States between the years 1987-1991. Age-earnings profiles were estimated for pharmacists, college graduates and high school graduates. Rates of return to pharmacists and college graduates were compared and a ratio of the pharmacist rate to the college graduate rate was computed for each year. Results suggest a shortage of pharmacists in the United States. Enrollments in pharmacy schools and adopted changes in the training of pharmacists are discussed in relation to their effects on the pharmacist labour market.

The cost effectiveness of drug utilisation review in an outpatient setting

Drug utilisation review (DUR) has been adopted as a mechanism for balancing cost containment and quality in prescription drug programmes. In this article we review published DUR reports in order to examine the cost effectiveness of DUR in an outpatient setting. DUR reports are defined either as DUR studies, which examine patterns of drug use, or as DUR programmes, which examine patterns of drug use and subsequent efforts to alter drug use. An adequate cost-effectiveness analysis (CEA) is defined as one that used multiple methods to measure and evaluate patterns of drug use, and/or efforts to alter drug use, and that also performed an analysis of the costs of the review or intervention methods employed, with a focus on efficiency. DUR studies and programmes that satisfied all the criteria and thus fit the framework for conducting CEA were included; others that satisfied only some of the criteria were examined for the insights that they could contribute to a study of costs relative to outcomes. We identified 14 reports that could be categorised as DUR studies. Only 3 of these examined more than 1 method of measuring and evaluating drug use, thereby potentially fitting the CEA framework, but none included a cost analysis. Of the other DUR studies, only 1 contained estimates of costs for the DUR method employed, but since it examined only 1 DUR method it did not satisfy the criteria for an adequate CEA. Although such studies provide information about different methods of identifying drug use patterns (a somewhat intermediate outcome), they do not provide insight into the cost effectiveness of methods designed to influence drug use. We identified 34 reports of DUR programmes. Only 5 of these reports fit the CEA framework; they examined multiple efforts to change drug use patterns (after identifying drug use patterns). None of them satisfied the criteria for an adequate CEA; in 3 of the reports no costs were provided, and the other 2 provided only partial input costs or costs for only some of the interventions designed to change drug use. DUR programmes were grouped by drug or drug use issue in an attempt to gain insights by comparing reports on similar drugs. The drugs or drug classes and number of reports reviewed were: cephalosporins (3); chloramphenicol (3); antiulcer drugs (2); dextropropoxyphene (2); tranquillisers (benzodiazepines) {3}; anti-infective agents (5); 'all drugs' (7); and other drugs/miscellaneous (9).(ABSTRACT TRUNCATED AT 400 WORDS)