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The objectives of this study were (1) to develop a scale to measure patient preferences for using medical care, (2) to assess the reliability and validity of the scale, and (3) to examine factors predicting preferences. Preferences were defined along a continuum, anchored by self-treating preferences and care-seeking preferences. A 9-item scale was developed and mailed to a random sample of 3500 Wisconsin consumers age 50 and older. Ordinary least squares regression was used to examine whether preferences were predicted by demographic and health status variables. A 56.9% usable response rate was obtained. The Medical Care Preference Scale was unidimensional and had a Cronbach's alpha of 0.879. Younger individuals, women, individuals in better health, and individuals from rural areas had significantly stronger self-treating preferences. Significant correlations between the preference scale and 2 measures of health care utlization provided evidence of predictive validity. Individuals with care-seeking preferences used an average of 1.98 more prescription drugs and had 0.50 more physician visits in the past month than individuals with self-treating preferences. The Medical Care Preference Scale should be a useful tool for research on health care utilization. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic resulted in health care workers experiencing temporary or permanent changes in employment due to layoffs, quits, and postpandemic increased job demand. Analyzing the association of the COVID-19 pandemic with employment changes and results of changes for practicing pharmacists and understanding the associations with demographic and work-related factors could inform practice, policy, and educational programs. This study aimed to explore the frequency, characteristics, and results of employment status changes (ESCs) experienced by pharmacists practicing pharmacy in March 2020 (ie, the start of the COVID-19 pandemic)., Methods: A descriptive, cross-sectional survey research design was used to collect data from a random sample of 93,990 licensed pharmacists in the United States. The study team developed an online survey questionnaire designed to assess the impacts of the COVID-19 pandemic on pharmacists' work and work-life. The survey items used for this study related to ESCs, work-life characteristics, work characteristics in March 2020 and 2022, and demographic variables. A total of 4947 usable responses were received between November 2022 and January 2023., Results: Overall, 36.4% of respondents reported experiencing an ESC and approximately 70% of those reporting an ESC reported experiencing just 1 ECS. Overall, 39.5% of respondents who experienced an ESC stopped working (ie, were unemployed) pursuant to an ESC. Respondents who experienced an ESC reported significantly lower levels of work exhaustion and interprofessional disengagement and significantly higher levels of professional fulfillment in their current employment than respondents that did not experience an ESC., Conclusion: The overall increase in demand for workers in the health care sector appeared to provide opportunities for pharmacists, especially pharmacists with 1 to 10 years of experience, to change their employment situation, resulting in better work-life characteristics. Given projections of a pharmacist shortage, research, policy, and educational programs could determine the best practices to improve work settings and the work-life characteristics of practicing pharmacists to improve the health of the current pharmacist workforce., (0002‐9459/© 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice., (© Individual authors.)

Purpose: The purpose of this study was to describe the demographics, training, clinical specialties, and practice activities of ambulatory care pharmacists using data from the 2019 National Pharmacist Workforce Study (NPWS)., Summary: The 2019 NPWS was conducted using a 3-contact electronic survey sent to a random sample of 94,803 pharmacists using the National Association of Boards of Pharmacy Foundation e-Profile system. The 2019 NPWS had a response rate of 67.3% (5,705/8,466), based on the number of prospective respondents who clicked the survey link. A subset of pharmacists' responses (n = 4,557) was used for this analysis, which included those who selected an employment status of "practicing as a pharmacist." Of the 4,557 actively practicing pharmacists responding, 338 (8.0%) reported working in the ambulatory care setting. Ambulatory care pharmacists were predominately White (71.6%), women (67.5%), and/or between the ages of 31 and 40 years (36.9%). A total of 41.3% had completed PGY1 residency training, 14% had completed PGY2 residency training, and 29.3% had completed one or more board certifications. Their most common clinical specialty areas were anticoagulation (21.7%), endocrinology (19.7%), hematology/oncology (16.2%), and primary care (16.2%). A total of 49.6% reported using a collaborative practice agreement., Conclusion: Ambulatory care pharmacists reported more training and certifications than the overall sample of pharmacists. These pharmacists practiced in a variety of clinical specialty areas and engaged in a range of in-person and telecommunication medication management activities. This study provides a baseline assessment of the ambulatory care pharmacist workforce that can be used to assess changes over time., (© American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes., Objectives: The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership., Methods: The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics., Results: Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898)., Conclusion: Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Job stress, burnout, and fulfillment can be modeled using the Job Demands and Resources model (JD-R)., Objective: This study explores the relationship between job demands and burnout and professional fulfillment in pharmacists, and the moderating role of job resources., Methods: Data were obtained from the 2019 National Pharmacist Workforce Survey of a random sample of U.S. licensed pharmacists. The survey assessed pharmacist demographics (age, gender, and work setting), job demands (workload and work-home conflict), job resources (job control, time spent in various work activities, and social support), as well as burnout and professional fulfillment. Hierarchical regression analyses were used to assess the relationship between job demands-resources variables and pharmacists' professional fulfillment and burnout. Moderation was assessed by including interaction terms (job demands x job resources) in the regression models. The change in marginal mean burnout and professional fulfillment for different combinations of job demands and job resources was used to assess the salience of significant moderation effects., Results: Women and community pharmacists accounted for 64.8% and 45.8% of the study sample, respectively. Age was negatively associated with burnout. Job demands were positively associated with burnout and negatively associated with professional fulfillment, and the converse was true for job resources. Significant moderation effects were observed for 7 out of 12 interaction terms assessed. The moderating effect of job resources was more salient under varying conditions of job demands in 5 out of 7 instances where significant interaction effects were observed., Conclusion: While pharmacist characteristics explained a significant amount of variation in burnout and professional fulfillment, also considering the moderating effects of job resources on the association of job demands with burnout and professional fulfillment identified additional information, such as the increased importance of job control and task variety in high workload environments., (Copyright © 2022. Published by Elsevier Inc.)

Background: Medication non-adherence is a significant public health problem. Patient-reported outcomes (PROs) offer a rich data source to facilitate resolution of medication non-adherence. PatientToc™ is an electronic PRO data collection software originally implemented at primary care practices in California, United States (US). Currently, the use of standardized PRO data collection systems in US community pharmacies is limited. Thus, we are conducting a two-phase evaluation of the spread and scale of PatientToc™ to US Midwestern community pharmacies. This report focuses on the first phase of the evaluation. The objective of this phase was to prepare for implementation of PatientToc™ in community pharmacies by conducting a pre-implementation developmental formative evaluation to (1) identify potential barriers, facilitators, and actionable recommendations to PatientToc™ implementation and (2) create a draft implementation toolkit., Methods: Data collection consisted of demographics, observations, audio-recorded contextual inquiries, and semi-structured interviews with staff (e.g., primary care providers, pharmacists, pharmacy technicians) and patients during 1-day site visits to a purposive sample of (1) primary care practices currently using PatientToc™ and (2) community pharmacies in Indiana, Wisconsin, and Minnesota interested in the future use of PatientToc™. Post-visit site observation debriefs were also audio-recorded. Verbatim transcripts of all recordings were coded using deductive/inductive approaches and intra-/inter-site summaries were produced identifying potential barriers, facilitators, and actionable recommendations mapped to the Consolidated Framework for Implementation Research constructs. A stakeholder advisory panel engaged in an Evidence-Based Quality Improvement (EBQI) implementation process. This included "member checking" and prioritizing findings, and feedback on the adapted PatientToc™ application, implementation strategies, and accompanying toolkit for community pharmacy implementation., Results: Two primary care practices, nine pharmacies, and 89 individuals participated. Eight major themes (four barriers and four facilitators) and 14 recommendations were identified. Throughout the four EBQI sessions, the panel (1) confirmed findings; (2) designated high priority recommendations: (a) explain PatientToc™ and its benefits clearly and simply to patients, (b) ensure patients can complete questionnaires within 10 min, and (c) provide hands-on training/resources for pharmacy teams; and (3) provided feedback on the adapted PatientToc™ application and finalized toolkit items for initial community pharmacy implementation., Conclusions: Adoption of electronically captured PROs in community pharmacies is warranted. The implementation strategies systematically developed in this study can serve as a model for implementation of technology-driven health information patient care services, in the understudied context of community pharmacies., (© 2022. The Author(s).)

Most research on pharmacist professional wellbeing has focused on measuring burnout. However, using valid and reliable instruments to assess professional fulfillment in pharmacists can expand understanding of pharmacists' professional wellbeing. This study aimed to (1) establish the validity of the Professional Fulfillment Index (PFI) for a sample of pharmacists licensed in the United States (US) using confirmatory factor analysis (CFA), and (2) compare the professional wellbeing of pharmacists across demographics and work settings. Data for this study were obtained from the 2019 National Pharmacy Workforce Survey (NPWS). The survey assessed pharmacist professional wellbeing using the PFI. The model fit of the PFI was assessed using CFA. Multiple linear regression was used to compare pharmacist wellbeing across demographics and work settings. The CFA affirmed that the PFI possesses a satisfactory model fit for use in pharmacists. Regression analysis showed higher burnout (work exhaustion and interpersonal disengagement) was associated with decreasing age, being female, working more hours, and working in a community pharmacy. Higher professional fulfillment was associated with men, and working in non-community pharmacy work settings. The PFI is a psychometrically reliable and valid instrument for assessing the professional wellbeing of pharmacists.

Background: Most pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States., Objectives: The purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex., Methods: The 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy., Results: The most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was "hearing demeaning comments related to race or ethnicity" at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of "hearing demeaning comments about race or ethnicity." Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being "very unsatisfied" with the results of reporting discrimination and harassment to their employer., Conclusion: Discrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Prior national surveys have quantified unemployment in the pharmacy workforce, and recent surveys have occurred in a changing environment, with increased numbers of pharmacists in the labor market., Objectives: We sought to investigate the rate of unemployment and situations of unemployed pharmacists., Methods: Data from the 2019 National Pharmacist Workforce Survey were analyzed, focusing on an initial question about employment status and follow-up questions for unemployed respondents about whether they were seeking a job, the reason they were unemployed, and how long they had been unemployed., Results: Overall, 4.4% of the respondents were unemployed, with higher rates occurring for female pharmacists, older pharmacist cohorts, and respondents of color, with the highest rate occurring (9.3%) for Black pharmacists. Most (74.4%) of the unemployed pharmacists were seeking a job in pharmacy, but 16.6% were not seeking any job. Nearly two-thirds of the unemployed pharmacist respondents had left the workforce involuntarily, with men at higher rates than women. The youngest cohort of unemployed pharmacists was the least likely to be forced to leave and more likely to leave for workplace-related or personal reasons. Black pharmacists had the overall highest rate of leaving the workforce involuntarily. On average, the unemployed pharmacists had been out of work nearly 2 years (19.2 months), and the periods out of work ranged widely. Those seeking a job in pharmacy predominantly (75.7%) had been unemployed for 1 year or less. More than half of the pharmacists involuntarily unemployed had been unemployed for 6 months or less., Conclusion: An increased rate of unemployment and a higher proportion of those unemployed seeking work occurred in this most recent national survey of the pharmacist workforce. Differences in the extent of unemployment and whether leaving the workforce was voluntary or involuntary occurred in pharmacists of color and in some age cohorts., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

National Pharmacist Workforce Studies (NPWS) have been conducted in the U.S. every five years since 2000. This article describes the online survey methods used for the latest NPWS conducted in 2019 and provides an assessment for nonresponse bias. Three waves of emails containing a link to the online survey were sent to a random sample of about 96,000 pharmacists licensed in the United States. The survey asked about pharmacist employment, work activities, work-life balance, practice characteristics, pharmacist demographics and training. A total of 5467 usable responses were received, for a usable response rate of 5.8%. To assess for nonresponse bias, respondent characteristics were compared to the population of U.S. pharmacists and a benchmark, while a wave analysis compared early and late respondents. The pharmacist sample-population comparison and the benchmark comparison showed that the NPWS respondents had a higher percentage of female pharmacists and a lower proportion of young pharmacists compared to the population of U.S. pharmacists and the benchmark sample. In some contrast, the wave analysis showed that the early respondents had a higher percentage of males and older pharmacists compared to the late respondents. Both the wave analysis and the benchmark comparison showed that the NPWS respondents (and early respondents) had a lower percent of pharmacists with a PharmD degree than did the late respondents and the benchmark group. These differences should be considered when interpreting the findings from the 2019 NPWS.

Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, limited research assesses the translation of CER into clinical practice. The objective of this study was to analyze the association between CER evidence and prescribing trends within two markets of Type 2 diabetes mellitus. Methods: A retrospective analysis to determine the prescribing trends from 2006 to 2016 and an electronic literature search to identify CER comparing different drugs was conducted. Results: In glucagon-like peptide-1 (GLP-1) agonists market, CER showed superiority of Liraglutide. Prescribing of Exenatide twice daily dropped by 50% points as Liraglutide entered the market. In dipeptidyl peptidase-4 (DPP4) inhibitors market, CER did not suggest conclusive superiority. Nevertheless, Sitagliptin, the first entrant, continued to dominate throughout. Conclusion: CER evidence appeared to be associated with prescribing trends in GLP-1 agonists market; however, no associations were found in DPP4 inhibitors market. The translation of evidence into practice can be limited by the availability of superiority trials and timing of their availability.

The goal for this study was to use data from the most recently conducted National Pharmacist Workforce Survey to compare eight components of quality of work life for actively practicing pharmacists in the United States categorized by (1) work activity and (2) work setting. The eight components of quality of work life were: (1) time stress; (2) responsibility stress; (3) level of control; (4) work in harmony with home life; (5) home life in harmony with work; (6) job satisfaction; (7) professional commitment; and (8) organizational commitment. Data for this study were obtained from the 2014 National Pharmacist Workforce Survey. For inclusion in analysis, respondents needed to report that they were practicing as a pharmacist. In addition, they needed to provide usable responses for both their percent time devoted to medication providing and to patient care services. This resulted in a total of 1191 responses for the analysis. Data were analyzed using cluster analysis, factor analysis, Cronbach coefficient alpha, chi-square analysis, ANOVA, and linear regression. The findings provide a description of pharmacists&rsquo; quality of work life in 2014 and show how type of work, variety of work, and work setting categories are associated with quality of work life for pharmacists.

Objectives: To describe services provided by community pharmacies and to identify factors associated with services being provided in community pharmacies., Design: Cross-sectional national mail survey., Setting and Participants: Pharmacists actively practicing in community pharmacies (independent, chain, mass merchandisers, and supermarkets)., Outcome Measures: Frequency and type of pharmacy services available in a community pharmacy, including medication therapy management, immunization, adjusting medication therapy, medication reconciliation, disease state management, health screening or coaching, complex nonsterile compounding, and point-of-care testing., Results: With a 48.4% response rate, the survey showed that community pharmacies offered on average 3 of the 8 services studied. Pharmacy chains and supermarket pharmacies reported providing significantly more services than did mass merchandise pharmacies. The number of pharmacy services provided was positively associated with involvement in an interprofessional care team, innovativeness, and perceived workload. The number of pharmacy services was negatively correlated with having 3.5 or more pharmacy technicians on duty., Conclusion: Pharmacy chains and supermarkets are providing the most pharmacy services among community pharmacy settings. The number of services provided was associated with innovativeness, technician staffing, and perceived workload. Also, involvement with an interprofessional care team supported greater service delivery. Community pharmacies vary in their provision of services beyond dispensing., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the association between pharmacists' demographics, practice variables, worklife attitudes (e.g., work environment stress, control in the work environment, professional commitment, work-home conflict, and organizational commitment), and their perceived job alternatives., Design: Cross-sectional descriptive study., Setting: A representative nationwide sample of licensed pharmacists in the United States, 2014., Participants: A total of 1574 practicing pharmacists., Main Outcome Measures: A previously validated Likert-type scale was used to measure perceived job alternatives. Pharmacists reported their perception on how easy it would be to find a better job with the use of 17 common organizational characteristics. The higher the score, the easier they perceived it would be to find a new job., Results: The perceived job alternatives scale manifested 4 constructs: environmental conditions, professional opportunities, compensation, and coworkers. Multivariate regression analysis showed that organizational commitment was the most influential worklife attitude and was negatively associated with all constructs except better compensation. The higher professional commitment and environmental stress, the easier pharmacists perceive it would be to find a new job with better environmental conditions, such as better professional treatment by management. Younger pharmacists indicated higher perceived levels of ease in finding a job with better environmental conditions and professional opportunities. Male pharmacists also reported a higher perceived level of ease in finding an alternate job with better professional opportunities. White pharmacists perceived it would be easier to find a new job with better environmental aspects and compensation. No statistical significance was observed in perceived job alternatives among pharmacists practicing in different primary work settings after adjusting for other variables., Conclusion: Demographics and worklife attitudes were found to affect perceived availability of job alternatives. Organizational commitment was the most important factor inversely associated with pharmacists' perceptions of better job alternatives. Employers may retain pharmacists by constantly maintaining pharmacists' sense of belonging to their organizations., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: To describe the products with price changes and assess the impact of price changes on the products' price and affordability within the context of the Egyptian market., Methods: A descriptive pre-post observational study was conducted. We selected March through June 2013 as the post-change observation period. A matching pre-change observation period, one year earlier, was selected to be consistent with potential seasonal variation in product use., Results: It was found that 65.7% of the products with price changes were low-priced generic products. The overall average percent change in price was 24.7%. Before decree #499 implementation, the average affordability of the low-, medium-, and high-priced products was 0.25 days' wage, 2 days' wage, and more than 100 days' wage, respectively. After the implementation, the cost increase for the low- and medium-priced products was less than 0.1 days' wage, whereas the high-priced products' cost decreased by 11 days' wage., Conclusions: The policy change resulted in both price decreases and increases without substantive implications on affordability., (Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objectives: To examine changes from 2009 to 2014 in variables related to whether, how much, and where licensed pharmacists worked as pharmacists. Comparisons were made separately for men and women pharmacists., Design: Data were obtained from 2 cross-sectional, descriptive surveys of licensed pharmacists and represented 1394 pharmacists in 2009 and 2446 pharmacists in 2014. The useable response rates to the surveys were 52.3% and 48.2%, respectively., Setting: United States., Main Outcome Measures: We examined the work status, the work setting, work position, and age distribution of actively practicing pharmacists. We studied the proportion of pharmacists working part-time overall and by age group and determined full-time equivalents (FTEs) by age group., Results: From 2009 to 2014, the proportion of licensed pharmacists that reported actively practicing pharmacy decreased for both men and women pharmacists. A significantly larger proportion of men pharmacists reported being retired in 2014 compared with 2009. In 2014, women represented a majority of actively practicing pharmacists and pharmacists in management positions. The proportion of actively practicing women pharmacists that worked part-time decreased from 2009 to 2014, and the FTE contribution of women pharmacists was approximately equal to men pharmacists in 2014. The proportion of pharmacists working in community practice settings decreased from 2009 to 2014., Conclusion: The period 2009 to 2014 appears to have been a time of great change in the pharmacist workforce and for work participation by pharmacists, reinforcing the need to continue to monitor changes that affect work participation by pharmacists., (Copyright © 2016. Published by Elsevier Inc.)

Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant's home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure feedback may have promise as part of a multi-method approach involving blood pressure screening and follow up.

Background: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct in pharmacy workforce, is important to measure the number of vacancies and assess pharmacist shortage consistently over time. Latent demand or potential demand is a novel construct and has never been measured in pharmacy workforce. With the increase in supply, it is important to measure the potential demand that could be budgeted in pharmacies in the near future., Objective: The objective of this study was to measure the unmet and latent demand for pharmacists and explore the association between latent demand and workload characteristics in community and hospital pharmacies in Wisconsin in 2011-12., Methods: The study used a cross-sectional, descriptive survey design. A sample of community pharmacies (n=1,064) and hospital pharmacies (n=126) licensed in Wisconsin in 2011-12 was identified. Key informants (managers/owners) of sampled pharmacies were sent a one-page cover letter explaining the purpose of the study and requesting participation and a three page survey form. The main outcome measures of the study were total number of FTE pharmacist positions vacant, presence of adequate staff size, additional number of FTE pharmacist positions needed to attain adequate staff size, prescription volume, daily census, hospital size and number of hours prescription department is open. Descriptive statistics were calculated for all the pharmacies collectively, then separately for community and hospital pharmacies. Pharmacy setting, vacancies and workload characteristics of pharmacies with and without latent demand were compared using chi-squared test of independence and/or t-test. Sample weights were calculated and used in all the analyses to weigh the estimates to all pharmacies in Wisconsin., Results: Overall response rate to the survey was 50.1%. Of the total number of FTE pharmacist positions budgeted in Wisconsin, 54.3 FTE positions (1.5%) were reported vacant in 2011-12. Approximately 28.2% of the community and hospital pharmacies reported the presence of latent demand. Latent demand was significantly associated with higher workload in community pharmacies and larger bed size in hospital pharmacies., Conclusion: There appeared to be a balance between the supply and demand for pharmacists in Wisconsin in 2011-12. There is a potential for additional FTE positions (latent demand) to be budgeted in pharmacies to attain adequate pharmacist staff size. It is important to consistently track the level of unmet and latent demand for pharmacists in Wisconsin and combine this information with other workforce characteristics to guide the decision making of pharmacy workforce planners and pharmacy managers.

Background: Although the benzodiazepine exclusion policy in the U.S. Medicare Part D drug coverage program has been studied, little information is available on individual use and switching patterns between benzodiazepines and substitute medications. Patients voluntarily were continuing or stopping benzodiazepines or switching to substitute medications. These individual-level outcomes can provide information beneficial to providers and policymakers to better understand the intended and unintended consequences of exclusion policies., Objective: The objective was to determine the effect of the Medicare Part D benzodiazepine exclusion on the utilization patterns of benzodiazepines and substitute medications by a select group of Medicare beneficiaries for a year following implementation of the exclusion. This research focused on the examination of the within-person patterns of benzodiazepine use and factors associated with these patterns., Methods: A quasi-experimental, comparative study was used to analyze prescription patterns and multinomial regression models were applied to investigate factors predicting different benzodiazepine use patterns. Pharmacy dispensing data for continuously eligible Medicare beneficiaries with at least one benzodiazepine fill in 2005 were reduced to a comparison group of 216 individuals with continual coverage and an intervention group of 250 individuals who lost coverage for benzodiazepines. Four individual patients' drug use patterns, continuation, switch, fluid movement, and cessation were identified by sorting and arraying pharmacy dispensing data to apply systematic drug file review. Multinomial regression models were used to examine the impact of coverage, demographic, medical, economic, and pharmaceutical factors., Results: Significantly more Medicare seniors who lost benzodiazepine coverage switched to potential substitute medications than those who continued to have coverage. Interestingly, 12 percent of affected seniors and 6 percent of unaffected seniors switched from and back to benzodiazepines (fluid movement). Zolpidem was the most popular substitute agent despite being an expensive brand-name drug. Regression models revealed that affected individuals had nearly two times the odds of engaging in switch-related patterns than those who had continuous coverage. Also, women were twice as likely to discontinue benzodiazepines as men., Conclusions: More seniors who lost benzodiazepine coverage engaged in medication switching, and women were more likely to stop benzodiazepines after the implementation of the exclusion policy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: False and misleading advertising for drugs can harm consumers and the healthcare system, and previous research has demonstrated that physician-targeted drug advertisements may be misleading. However, there is a dearth of research comparing consumer-targeted drug advertising to evidence to evaluate whether misleading or false information is being presented in these ads., Objective: To compare claims in consumer-targeted television drug advertising to evidence, in order to evaluate the frequency of false or misleading television drug advertising targeted to consumers., Design: A content analysis of a cross-section of television advertisements for prescription and nonprescription drugs aired from 2008 through 2010. We analyzed commercial segments containing prescription and nonprescription drug advertisements randomly selected from the Vanderbilt Television News Archive, a census of national news broadcasts., Main Measures: For each advertisement, the most-emphasized claim in each ad was identified based on claim iteration, mode of communication, duration and placement. This claim was then compared to evidence by trained coders, and categorized as being objectively true, potentially misleading, or false. Potentially misleading claims omitted important information, exaggerated information, made lifestyle associations, or expressed opinions. False claims were factually false or unsubstantiated., Key Results: Of the most emphasized claims in prescription (n = 84) and nonprescription (n = 84) drug advertisements, 33 % were objectively true, 57 % were potentially misleading and 10 % were false. In prescription drug ads, there were more objectively true claims (43 %) and fewer false claims (2 %) than in nonprescription drug ads (23 % objectively true, 7 % false). There were similar numbers of potentially misleading claims in prescription (55 %) and nonprescription (61 %) drug ads., Conclusions: Potentially misleading claims are prevalent throughout consumer-targeted prescription and nonprescription drug advertising on television. These results are in conflict with proponents who argue the social value of drug advertising is found in informing consumers about drugs.

Patent expiration of brand-name pharmaceuticals creates opportunities for large savings for state Medicaid programs because generic versions of medications frequently represent a lower-cost alternative. State Medicaid programs that quickly recognize the availability of generics and adjust their drug payments in response to falling market prices can obtain the greatest benefit. We examined one such case: the movement to generic fluoxetine following patent expiration for Prozac, a widely prescribed antidepressant and an expensive drug for Medicaid. We found large differences in states' responses to generic availability. States took between two and ten calendar quarters to reach 90 percent use of generic rather than brand-name fluoxetine and four to eight quarters to achieve a 50 percent decrease in reimbursement per pill. We estimated that states failed to realize $220 million in uncaptured savings during 2001-05. By coordinating their efforts, perhaps with federal help, states could gain access in a more timely way to market prices for generic drugs and, hence, take greater advantage of the savings that those drugs offer.

Background: Some pharmacists have changed the focus of their practice from solely dispensing. Emerging services they have added include medication therapy management and other pharmacy services., Objective: To assess the effect of entrepreneurial orientation, resource adequacy, and pharmacy staffing on pharmacy practice change., Methods: A total of 1847 licensed U.S. pharmacists received 2 mail surveys as part of a larger national pharmacist survey. The core survey collected information about practice setting, prescription volume, and staffing. The supplemental survey assessed how the pharmacy had changed over the past 2 years to enable the delivery of pharmacy services. The amount of change was assessed by 12 items, which were summed to provide an aggregate change index. Five variables from organizational change literature were assessed as influences on practice change: proactiveness, risk taking, autonomy, work ethic, and adequacy of resources. In addition, the associations of pharmacist and technician staffing with practice change were assessed. A multiple linear regression analysis was performed with the aggregate change index as the dependent variable and the 7 potential influences on change as the independent variables., Results: Four hundred usable surveys were analyzed. At least some level of practice change was reported in 60% of pharmacies surveyed. The linear regression analysis of the model was significant (P<.001) with an R-square value of 0.276. Significant influences on change were 2 dimensions of entrepreneurial orientation-proactiveness and autonomy-as well as adequacy of resources and pharmacy technician staffing., Conclusions: Many pharmacies reported that some aspects of their practice have changed, such as collecting patient information and documenting care. Few reported changes in asking patients to pay for pharmacy services. These findings support previous results, which show that the capacity for organizational change can be augmented by increasing proactiveness, autonomy among employees, and the availability of adequate and appropriate resources., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: A large-scale national survey was conducted to assess the general public's attitudes about, need for and satisfaction with community pharmacists and the services they provide in Taiwan., Method: Computer-assisted telephone interviews were conducted by a contract agency using random-digit dialing procedures to achieve a nationally representative sample of adult residents. An 18-item interview survey questionnaire was developed based on previous similar surveys and a pretest-type process was employed by monitoring early responses of interviews to ensure understanding by respondents., Key Findings: A total of 9066 phone exchanges were dialed resulting in 2658 conversations with potential respondents and 1089 completed interviews. Overall, 45.6% of respondents agreed that community pharmacists always treat them sincerely and 41.2% agreed that community pharmacists have the ability to answer their questions. Fewer respondents agreed that community pharmacists were the first professional they consulted for answers about medication use (31.7%) and that they generally trusted the pharmacist (33.2%). Older respondents had more favourable perceptions and respondents with more education had less favourable perceptions. About half of the respondents reported a need for medication use instructions, help in developing personal medication records and help in filling chronic-disease prescriptions. A majority of respondents were satisfied with specific pharmacist services; however, only 8.5-22.5% of respondents previously had experienced these services. Fewer respondents reported general satisfaction with community pharmacist services., Conclusion: Although generally consumers had less-than-positive perceptions about community pharmacists, their responses revealed some level of trust of pharmacists, awareness of the services that pharmacists may be able to provide and satisfaction with services provided by pharmacists., (© 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.)

Background: Under the 1995 Wisconsin Act 27, the biennial budget, Wisconsin Medicaid was required to develop an incentive-based pharmacy payment system for pharmaceutical care (PC) services. Started on July 1, 1996, the Wisconsin Medicaid Pharmaceutical Care Program (WMPCP) is the longest currently ongoing Medicaid program to compensate pharmacists for nondispensing services. The program reimburses pharmacies for providing PC services that increase patient compliance or prevent potential adverse drug problems by paying an enhanced PC dispensing fee. Pharmacists can bill for PC services provided to Wisconsin Medicaid fee-for-service and SeniorCare (i.e., state prescription drug assistance program for low-income seniors) beneficiaries., Objectives: To examine trends in (a) the number of pharmacies participating in the WMPCP and the intensity of participation among participating pharmacies; and (b) frequencies of reason, action, result, and level-of-service (time) codes associated with PC service claims from July 1, 1996, through June 30, 2007, which represents Wisconsin state fiscal years (SFYs) 1997 through 2007., Methods: A retrospective, longitudinal, and descriptive research design was used to analyze all paid claims for PC services provided to Wisconsin Medicaid fee-for-service and SeniorCare recipients during SFYs 1997 through 2007. The total number of paid PC claims and the average number of claims paid per pharmacy were examined to determine trends in pharmacy participation. Mean annual reimbursement amounts for PC per claim and per pharmacy were calculated. Reason, action, result, and level-of-service (time) codes that appeared in the claims were grouped into categories and analyzed to characterize the total number of claims paid overall and per SFY., Results: During the study period, one-half (n = 601) of the approximately 1,200 licensed pharmacies in the state of Wisconsin were paid for a claim through the WMPCP. However, intensity of participation in the WMPCP was low, with 57% of all participating pharmacies being paid for 10 or fewer PC claims and 19% paid for only 1 PC claim over the 11-year study period. The growth in claims per year coupled with smaller growth in the number of participating pharmacies resulted in a trend of growth in the mean number of claims per participating pharmacy in the program. The proportion of total WMPCP claims accounted for by the top 10 pharmacies with the highest volume of PC claims varied from 46.6% to 80.2% per year. Patient behaviors (e.g., early or late refills) and drug use issues/problems (e.g., patient complaints or symptoms) were the most common reasons for pharmacists to provide PC services (62% of all PC claims), although drug choice reasons (e.g., product selection opportunity) were more common after 2004. The majority (55.1%) of PC services took 15 minutes or less of pharmacists' time. The total dollar amount paid to pharmacies for PC services was $876,822 between SFYs 1997 and 2007, with an overall mean of $1,459 paid per participating pharmacy., Conclusions: Trends in pharmacy participation and claims volume showed growth, albeit limited, in PC program participation with a majority of paid claims dealing with patient behaviors and drug use issues or problems that consumed a small amount of pharmacists' time (15 minutes or less). The intensity of participation (claims per pharmacy) increased over time, suggesting that some pharmacies may have developed effective systems for participating and successfully submitting claims to WMPCP for enhanced dispensing fees. Further evaluation of the impact and implications of this program for patients, pharmacists, and the state is needed to gauge overall program success and provide evidence or guidance for continued or expanded PC initiatives.

The objective of this study was to measure differences in fair balance (benefit and risk statements) and adequate provision (toll-free numbers, Internet URLs, print ad references, and medical professional references) in advertising content for drugs that have switched from prescription to over-the-counter (OTC). The Vanderbilt TV News Archive was used to select products to study, to measure the frequency and placement of ads for those products, and to view advertising content for those products. Unique advertisements (n = 108) for loratadine (Claritin), citirizine (Zyrtec), and omeprazole (Prilosec) were analyzed for the presence of adequate provision statements and for the frequency of benefit, risk, and other statements. OTC ads were shorter than prescription ads by 10.6 seconds but contained the same total number of statements. Most prescription ads (n (RX) = 31) contained toll-free numbers (97%), Internet URLs (94%), medical professional references (100%) and print ad references (68%). Few OTC ads (n (OTC) = 77) contained adequate provision statements: 4% contained toll-free numbers and 10% contained Internet URLs. Prescription ads had similar numbers of benefits (1.5) and risks (1.8) per 30 seconds of ad time, and OTC ads had more benefits (6.6) than risks (1.2) per 30 seconds of ad time. Prescription drug ads contained risk statements that listed specific side effects and explicit harms from taking the product, but OTC ads contained nonspecific risk information and statements that implied risk rather than directly identifying risk. Differences in the Food and Drug Administration (FDA) and Federal Trade Commission (FTC) regulation of advertising affected the balance of risk and benefit information that appeared and the specificity of risk information available.

Objective: To determine (1) the frequency of the different types of drug therapy modification claims paid by a pharmacy benefits manager (PBM), (2) PBM cost savings and return on investment (ROI), and (3) patient savings from pharmacist-reimbursed drug therapy modifications., Design: Cross-sectional, retrospective, descriptive study., Setting: Midwest United States in 2006., Patients: Not applicable; 767 paid therapeutic interchange service claims from the PBM database were analyzed., Intervention: Descriptive statistics for PBM costs and cost savings to the PBM and to patients were calculated using all prescription fills., Main Outcome Measure: ROI calculated by dividing net savings across all fills by net costs., Results: Claims were paid to pharmacists for drug therapy modifications to allow tablet splitting, drug therapy changes, and switching noncovered drugs. Tablet splitting provided the largest cost savings to the PBM, accounting for slightly more than one-third of the claims and representing more than one-half of the prescription fills. Switching drugs not covered provided the largest cost savings to patients. Overall, the PBM saved a mean of $20.31 per prescription fill, and patients saved $14.76 per prescription fill. Mean overall ROI to the PBM was 3.55., Conclusion: Payment for pharmacist interventions can be an economic benefit for both patients and third-party payers. The cost savings for payers likely will dictate the endorsement of pharmacist-reimbursed programs and economic incentives offered to pharmacists and pharmacies.

Objective: To compare practice settings and activities of pharmacists with bachelor of science (BS) in pharmacy and doctor of pharmacy (PharmD) degrees., Methods: Data from the 2009 National Pharmacist Workforce Survey instrument were analyzed. Multivariate regression was used to examine the association of the PharmD degree with time spent in dispensing and patient care., Results: The survey response rate by pharmacists was 52%, and 562 usable responses met our inclusion criteria. Sixty-three percent of BS and 39% of PharmD pharmacists were employed in community pharmacies, compared with 21% of BS and 38% of PharmD pharmacists employed in hospital pharmacy settings. Practicing in a community setting had the strongest influence on time spent in dispensing and time spent in patient care. Among respondents with PharmD degrees, a residency was associated with less time in dispensing and more time in patient care., Conclusion: Time spent in dispensing and patient care were influenced more by practice setting than by educational degree and residency training.

Background: Measuring community pharmacists' self-efficacy in performing medication therapy management (MTM) services can be useful for tailoring interventions and predicting participation., Objective: To identify relevant survey constructs related to the Wisconsin Pharmacy Quality Collaborative (WPQC) MTM program and to evaluate scale validity., Methods: The 31-item MTM self-efficacy scale was developed using previous research, identifying critical program components, and beta testing. After administration to pharmacists in the 53 WPQC pilot sites, summary statistics and exploratory factor analysis (EFA) were conducted. Parallel analysis was used to determine the optimal number of factors. Internal consistency reliabilities were calculated., Results: Baseline participation rate was 94% (N=76). The 11-point scale (0-10) item means ranged from 2.83+/-3.05 to 7.82+/-2.19. Parallel analysis produced a 3-factor solution, accounting for 56% of the variance. Low-factor loadings or unacceptably high cross loadings resulted in 17-item deletions. The final EFA on the remaining 14 items retained the original 3-factor solution and increased the proportion of explained variance (72%). The factors relate to MTM tasks (alpha=0.92), personal interactions (alpha=0.86), and goal setting (alpha=0.84). Overall Cronbach's alpha=0.90., Conclusion: Constructs for measuring self-efficacy were identified that may aid in future research predicting whether pharmacists engage in and persist in providing MTM services., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: Medicare Part D was expected to have differential impacts on patient drug expenditures and use based on beneficiaries' levels of pre-Part D patient drug spending, but it is unknown whether these projections have borne out., Objectives: We sought to evaluate whether and how the policy effect of Medicare Part D on drug expenditures and use was modified by levels of pre-Part D drug spending., Methods: A quasi-experimental, pretest-posttest, nonequivalent control group design was used. Data were obtained from a regional supermarket chain for all prescriptions dispensed between January 1, 2005, and December 31, 2007 (n=1,230,612) to patients aged 60 years and older as of January 1, 2005 (n=51,305) to construct 12-month pre-Part D and post-Part D periods. Annual medication use was measured as the total number of pill days acquired. Annual drug expenditures were measured as total expenditures, patient out-of-pocket expenditures, and the proportion of total expenditures paid out of pocket by the patient., Results: Part D resulted in significant reductions in out-of-pocket spending (17.6%) and significant increases in drug use (4.0%) for individuals in the highest pre-Part D drug-spending group relative to controls. The reduction in out-of-pocket spending for the highest pre-part D spending group was significantly greater compared with the moderate and lowest pre-Part D spending groups., Conclusions: Our findings suggest that, as expected, Part D facilitated access to medications for patients who previously experienced the greatest costs without adversely increasing use and costs among those with the lowest prior cost., (Copyright 2010 Elsevier Inc. All rights reserved.)

Context: Higher prevalence of chronic diseases and reduced access to other health professionals in rural areas suggest that rural Medicare enrollees will benefit from pharmacist-provided drug therapy services (DTS)., Purpose: The purpose of this study was to describe non-metropolitan community pharmacy sites in Wisconsin, the provision of DTS at these sites, and to identify factors associated with provision of DTS., Methods: A cross-sectional, descriptive survey design was used to collect primary data in 2005. The manager/owner listed for each of the 279 non-metropolitan community pharmacy sites in Wisconsin was surveyed using an 8-page instrument. The 7 drug therapy services that key informants were asked to report on included 6 disease state management (DSM) programs and medication therapy management services (MTMS). Descriptive statistics were calculated for variables describing the pharmacy sites and how DTS were provided. Logistic regression was performed, with any drug therapy service provision as the dependent variable and 8 independent variables., Findings: The response rate to the survey was 44%. Overall, 31% of the respondent pharmacies offered MTMS and 31% offered DSM programs. Higher service orientation, location in a more rural area, and lower workload per pharmacist were significantly positively related to provision of any DTS., Conclusions: Conducted 4 months prior to the implementation of Medicare Part D, the results serve as a baseline against which the effects of Part D on MTMS provision may be evaluated. The negative association of pharmacist workload with pharmacy provision of DTS, coupled with the current pharmacist shortage, has important implications for patients' access to these services in rural areas.

Objectives: To measure and describe the level of unmet demand for pharmacists in rural Wisconsin community pharmacies and to examine determinants of the level of unmet demand in these pharmacies., Design: Cross-sectional descriptive study., Setting: Community pharmacies (n = 279) located in rural Wisconsin counties in fall 2005., Participants: Key informants (managers/owners) identified for all sampled pharmacies., Interventions: A one-page participation form and an eight-page survey instrument were used to collect primary data about the level of unmet demand for pharmacists and internal pharmacy factors. Secondary data sources were used to extract information on external pharmacy factors., Main Outcome Measures: Presence of pharmacist vacancy, number of full-time equivalent (FTE) pharmacist positions vacant, and vacancy rate. Internal pharmacy characteristics included wage, prescription volume, prescription workload/pharmacist, dispensing-aiding technologies, technicians per pharmacist, practice setting, pharmacist FTE requirement, and pharmacist satisfaction. External pharmacy characteristics included population per pharmacy, seniors per pharmacy, per capita income, and rurality. The internal and external pharmacy characteristics were regressed on whether a vacancy was present and the vacancy rate (percentage of pharmacist FTEs unfilled)., Results: Overall response rate to the survey was 43.9%. One-third of the respondent pharmacy sites reported a pharmacist vacancy, most often 1.0 or less FTE. Pharmacist FTE requirement had a significant positive association with the presence of any pharmacist vacancy at a site. Prescription workload per pharmacist was positively related to the vacancy rate, while daily prescription volume and pharmacist satisfaction were negatively related to the vacancy rate., Conclusion: Overall, for rural community pharmacies in Wisconsin, a greater need for pharmacists at a site appears to make that site more likely to have a pharmacist vacancy. Pharmacist vacancies appear to have a greater impact on pharmacies that have a lower number of FTE pharmacist positions compared with pharmacies with higher FTE pharmacists because, potentially, fewer pharmacists are present to redistribute the workload.

Objectives: To examine the association between individual (demographic) and organizational (work environment and workload) factors and pharmacists' future work plans and explore reasons for either leaving or staying with current employers (culture/climate factors)., Design: Cross-sectional study., Setting: United States in 2004., Participants: 1,263 pharmacists., Intervention: Seven-page mail survey., Main Outcome Measures: Future work plans, time spent in practice activities, staffing levels, and actual and perceived workload and demographic variables., Results: Overall, 15% of respondents reported that they planned to leave their current employer within the year subsequent to this survey. More than 50% reported that their workload had significantly increased in the previous year. Multivariate analyses showed that nonwhites were 2.1 times more likely to be planning to leave their current employer, compared with whites, and unmarried respondents were 1.7 times more likely to leave than were married individuals. More negative perceptions regarding the impact of workload on various personal, work, and patient care outcomes predicted leaving. A main factor that prompted their inclinations was described by 72% of leavers (insufficient and/or unqualified staff) and 49% of stayers (flexible scheduling). The most common reasons for staying were good salary and relationships with coworkers, while the most common reasons for leaving were a desire for change and stress/workload issues., Conclusion: Future work plans of pharmacists are influenced by a variety of individual, organizational, and culture/climate factors. While employers have little latitude for influencing demographic characteristics of employees, many organizational and culture/climate factors (scheduling, opportunities for interpersonal interactions, salary/benefits, staffing, and workload) can be addressed with the intent of reducing pharmacist turnover.

Objectives: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services., Design: Cross-sectional study., Setting: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies)., Participants: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey., Intervention: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists., Main Outcome Measures: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services)., Results: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index., Conclusion: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.

Objective: To examine work variables for licensed pharmacists for 1990, 2000, and 2004., Design: Three cross-sectional, descriptive studies., Setting: United States., Participants: Licensed pharmacists: 1,623 in 1990; 2,092 in 2000; and 1,564 in 2004. These numbers of usable responses to the three respective surveys represented 54.0%, 42.7%, and 33.8% of those receiving surveys., Intervention: Mailed survey from the 2004 National Pharmacist Workforce Survey; data from the national studies of the pharmacist workforce conducted in 1990 and 2000., Main Outcome Measures: Characteristics of pharmacists; work setting, work position and age distribution of actively practicing pharmacists. Work status of licensed pharmacists; proportion actively practicing pharmacy. Proportion of pharmacists working part-time overall and by age group, weekly hours worked by actively practicing pharmacists, and full-time equivalents (FTEs) by age group. Proportion of pharmacists with secondary pharmacy employment; work setting, hours worked, and weeks worked in secondary pharmacy employment., Results: In each year studied, more than 86% of licensed pharmacists were actively practicing pharmacy. In 2004, the largest proportion of actively practicing women pharmacists was between the ages of 31 and 45, and the largest proportion of actively practicing men pharmacists was between the ages of 46 and 60. Across the survey years, the proportion of all actively practicing pharmacists working part-time increased, and the proportion of women working part-time was at least double that of men except in 2004. In 2004, the FTE contribution for women was 0.81 and 0.91 for men., Conclusion: The decrease in FTE contributions by all pharmacists and the aging of the male pharmacist population raise concerns about the adequacy of current and future pharmacist supply. As the demand for pharmacists continues to evolve, pharmacy must continue to monitor the pharmacist workforce to show how pharmacists react to changes to better inform projections of the pharmacist workforce.

Objectives: To describe pharmacists' work activities in the United States during 2004 in terms of (1) the desired amount of time they would like to spend in each of four work activities (medication dispensing, consultation, business management, drug use management), (2) the amount of time they actually spend in each activity, and (3) the gaps between desired and actual time reported in each activity., Design: Cross-sectional study., Setting: Pharmacies (community chain, community independent, hospital, and other) in the United States., Participants: 1,564 actively practicing pharmacists., Intervention: Mailed survey from portions of the 2004 National Pharmacist Workforce Survey., Main Outcome Measures: Differences between desired and actual time spent in work activities in medication dispensing, consultation, business management, and drug use management and the associations between practice setting characteristics and demographic variables were explored using linear and logistic regression analyses. Practice variables included position, years in current position, working part time, work with other pharmacists, work with technicians, proportion of staff who are pharmacists, staff size, dispensing level. Demographic variables included age, gender, race, marital status, and year of licensure with respondents' reported work activity amounts and gaps. Linear regression results were interpreted based on standardized beta coefficients and corresponding P values. Logistic regression results were interpreted based on 95% confidence intervals for odds ratios., Results: The proportion of time pharmacists devoted to medication dispensing, consultation, business management, and drug use management did not change between 2000 and 2004. Practice setting was the most consistently influential variable on pharmacists' work activities when controlling for other variables. Pharmacists in all practice settings would like to spend more time in consultation and drug use management and less time in medication dispensing, but compared with community pharmacists, hospital and other patient care pharmacists were less likely to report a gap between desired and actual time spent in dispensing activities. Age was a significant predictor of gaps between desired and actual time spent in various activities, but only the oldest age groups (ages of 60 or 70 years and older) were significantly different from the reference group of pharmacists aged 23 to 30 years., Conclusion: Pharmacists would like to devote more of their time to consultation and drug use management activities in community pharmacy settings but have not yet been afforded a full opportunity to engage in these activities to the extent that they desire.

Objectives: To describe characteristics of community pharmacists' current practice environments and pharmacists perceptions' about aspects of their work environments., Design: Cross-sectional study., Setting: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies) in the United States., Participants: 1,564 actively practicing pharmacists., Intervention: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists., Main Outcome Measures: Hours the pharmacy was open; staffing; workload, perceptions of workload, and impact of the current workload on them and their work; equipment and technology available and used; and impact of equipment and technology at the practice site. Responses were compared with those from the 2000 National Pharmacist Workforce Survey., Results: Hours of operation varied across practice settings in 2004 and were similar to those reported in 2000. Pharmacist and technician staffing varied somewhat across settings, but overall pharmacists were working with more technicians in 2004 compared with 2000. The number of prescriptions personally dispensed daily (personal workload) increased for pharmacists in all practice settings from 2000 to 2004. When pharmacists reported the impact of their current workload, motivation to work at the pharmacy and job satisfaction were rated most positive, and opportunity to take adequate breaks were rated most negative. Equipment used for facilitating the dispensing process was more common in pharmacies than equipment related to patient care activities. More than one half of pharmacists reported that equipment and technology increased their level of productivity, quality of care, financial performance, and job satisfaction in the pharmacy., Conclusion: Pharmacists' work environments tend to be oriented toward traditional dispensing roles and activities. Staff, equipment, and information technology resources are available to facilitate both dispensing and patient care activities, and these resources have increased productivity, quality of care, and pharmacists' satisfaction.

Using the 1996-1999 Medicare Current Beneficiary Survey, we examine trends in nonacquisition of prescribed medicines among seniors. Each year less than 3 percent of seniors reported not getting the medicines that were prescribed for them, most often for economic reasons, but they also noted reasons relating to their preferences about using medicines. The presence or absence of drug coverage and chronic disease did not appreciably change this percentage, which suggests that a Medicare drug benefit may not greatly increase seniors' acquisition of their prescribed medicines.

Objective: To examine consumer risk perceptions for generic prescription drugs used to treat different types of medical conditions, and to explore the relationship between risk perceptions and the amount of cost savings required before consumers would purchase the generic version of a prescription drug., Design: Cross-sectional mail survey., Setting: Metropolitan area in central Wisconsin., Participants: Random sample of 500 consumers age 18 and older., Interventions: None., Main Outcome Measure: Responses to 16 items on 8-page questionnaire. None., Results: The response rate was 71.4%. The percentage of respondents who perceived that generic prescription drugs were riskier than brand name products varied from 14.2% to 53.8%, depending on the medical condition being treated. Significantly larger cost savings were required for consumers to purchase generic prescription drugs with higher perceived risk., Conclusion: Financial incentives to use generic prescription drugs may be successful, even for consumers who perceive generic drugs to be riskier than brand name prescription drugs. As the perceived level of risk increases, larger cost savings are required.

Objective: To measure the effect of a change in an insurance company's reimbursement formula on prescription department gross margins for all prescriptions and subgroups of prescriptions., Design: Retrospective descriptive analysis., Setting: Wisconsin., Participants: Two units of a chain pharmacy., Intervention: Reimbursement changed from usual and customary price to average wholesale price less 10% plus a $2.00 dispensing fee for single-source products, and maximum allowable cost plus a $2.00 dispensing fee for multisource products., Main Outcome Measure: Gross margins for prescriptions dispensed in the month before and after the reimbursement change., Results: The average estimated gross margin decreased 26.9% after the change in reimbursement, and the effect on the average gross margin for generic prescriptions was nearly twice that of the effect on the average gross margin for brand name prescriptions. The effect of the reimbursement change on different therapeutic classes ranged from an increase of 0.7% in the cardiovascular class to a decrease of 68.2% in the eyes, ears, nose, and throat class. The effect of the reimbursement change was greater for low-cost prescriptions than for high-cost prescriptions., Conclusion: The large effect of the reimbursement change, combined with continued growth in third party prescriptions, raises concerns about whether pharmacies can accept third party contracts with low reimbursement rates and still maintain current profitability and service levels.

Research on pharmacy benefit management companies focuses on descriptive accounts of the organizations and the scope of their services. This review provides a critical analysis of publicly available research on contemporary issues surrounding the operations and effects of pharmacy benefit management companies. There has been very little systematic, empirical research on these issues; major questions concerning the impact of pharmacy benefit management companies on quality, costs, and patient outcomes remain unanswered. We analyze what is known and what needs to be known, and we explore major research challenges that lie ahead in the assessment of the pharmacy benefit management company's role in the health care system and in improving the public's health.

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.

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.

Although prescription drugs do not appear to be a primary source of recent surges in Medicaid spending, their share of Medicaid expenditures has risen despite efforts to control costs. As part of a general concern with prescription drug policy, Congress mandated a study of the adequacy of Medicaid payments to pharmacies. In this study, several data sources were used to develop 1991 estimates of average pharmacy ingredient and dispensing costs. A simulation was used to estimate the amounts States pay. Nationally, simulated payments averaged 96 percent of estimated costs overall but were lower for dispensing costs (79 percent) and higher for ingredient costs (102 percent).

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)

A national mail survey of drug product management in health maintenance organizations (HMOs) is described. The survey covered 570 HMOs--502 by questionnaires mailed to pharmacy directors at individual independent and multistate HMOs and 68 represented by six executives of multistate HMOs who agreed to report aggregate data for their HMO operations. Responses for 180 individual HMOs were received (36% response rate); four of the six multistate HMO executives returned aggregate data. Individual HMO respondents reported using the following methods of drug product management: formularies, 66% (of these, 60% reported using a restrictive formulary or a restrictive formulary with exceptions); MACs, 54%; prior authorization, 44%; contracts for co-marketed and single-source drug entities, 46% for each. Almost all HMOs with contracts also had exclusive or preferred status for dispensing or reimbursement of some drug products. Most HMOs received discounts, manufacturer's value-added services, price protection, rebates based on market share, and rebates based on use as contract incentives; discounts and rebates based on use were chosen as the most preferred incentives. Established methods of drug product management, such as formularies and MACs, were most commonly reported by HMOs; however, nearly half reported using new approaches, including contracts with manufacturers, incentives, such as discounts and rebates based on use, and exclusive or preferred status.