Search

Introduction: Pharmacy education and postgraduate training in the United States (US) are esteemed, drawing international students to American Council for Pharmacy Education (ACPE)‐accredited schools and pursuing residency training after graduation. Despite this, limited literature addresses the obstacles international students face in pursuing American Society of Health‐System Pharmacists (ASHP) accredited residency programs. Objectives: To summarize potential eligibility barriers for international graduates of ACPE programs during the residency application process from residency program directors' (RPDs) perspectives. Methods: A 16‐question electronic survey was developed and distributed to all RPDs of US‐based ASHP‐accredited postgraduate year‐1 (PGY‐1) programs in July 2021. Questions addressed whether non‐US citizens were eligible to apply, barriers to recruiting non‐US citizen candidates, and barriers to offer visa sponsorships. Descriptive statistics were used to summarize the data. Results: A total of 196 programs responded to the survey (response rate, 13.5%). Eighty‐nine (45.4%) programs reported that candidates with F‐1/optional practical training (OPT) status were eligible to apply for their program, while 86 programs (43.9%) reported candidates were not eligible. Barriers for recruiting candidates with F‐1/OPT status included lack of resources to support application process (n = 42), citizenship requirements (n = 41), institution policy (n = 33), department preference (n = 12), and unfamiliar with procedures in selecting these candidates (n = 18). Over 70% (n = 146) would not offer visa sponsorship for pharmacy resident positions. Barriers to offering sponsorship were lack of support resources (n = 62), cost (n = 60), time preparing applications (n = 46), citizenship requirements (n = 45), and department preference (n = 23). Conclusion: This study investigates the obstacles encountered by non‐US citizens in the residency application process, as perceived by program directors. The primary obstacle in recruiting candidates with F‐1/OPT status and providing visa sponsorships revolves around the inadequate support and resources available for the application process. [ABSTRACT FROM AUTHOR]

Background: Medication nonadherence contributes to approximately US$290 billion per year in avoidable health-care spending. Statins are of particular interest because of their importance to patient outcomes, costs of treatment failure, and categorization as a Medicare star measure linked to financial reimbursement. Objective: To evaluate statin adherence as defined by the proportion of days covered (PDC) among patients who use an embedded dispensing pharmacy in a patient-centered medical home (PCMH). Methods: This study is a retrospective chart review of Lifetime Health Medical Group’s electronic health record and third-party prescription claims data of statin therapy. Statin adherence is reported using PDC, with 0.8 or greater considered adherent for statin therapy. Statistics used include 2-sample unpaired t test to compare PDC between gender and age, and analysis of variance was used to determine differences in PDC among different insurance types. Results: One hundred ninety-three patients were included, and 917 statin prescriptions were filled. PDC for statin medications in the population was 0.92 ± 0.20. Eighty-six percent of patients were considered adherent, with a PDC ≥80%. The average insurance and patient costs for brand prescriptions (n = 106) were US$233 ± US$143 and US$31 ± US$27, respectively, and costs for generic prescriptions (n = 811) were US$8 ± US$13 and US$7 ± US$6, respectively. Conclusion: Statin adherence rates for patients utilizing a dispensing pharmacy embedded in a large PCMH exceed the national average of 40% to 50% adherence. [ABSTRACT FROM AUTHOR]

Objectives: To report perceptions of PharmD candidates regarding a behind-the-counter (BTC) class of medications and to identify perceived barriers to its successful implementation. Methods: PharmD candidates in their second, third, and fourth professional years were invited to complete an online survey. Responses were used to assess perceptions of competency and willingness to participate in a BTC program and perceived preparedness of the current community pharmacy practice environment for a BTC class of medications with regard to 8 specific classes of medications. Results: The survey response rate was 28%. In all, 78% of respondents agreed or strongly agreed that a BTC class of medications is a change that they would be willing to embrace, and 54% agreed or strongly agreed that their PharmD curriculum provided them with adequate training in laboratory and diagnostic test interpretation. Less than half of the respondents agreed or strongly agreed that community pharmacies are currently equipped with the resources necessary to clinically assess a patient and dispense BTC medications. Conclusion: PharmD candidates are prepared and willing to participate in a BTC program but believe that the current community practice environment lacks access to resources necessary to do so. [ABSTRACT FROM AUTHOR]

Purpose To evaluate information provided by residency and fellowship programs to graduates of Accreditation Council for Pharmacy Education–accredited doctor of pharmacy programs holding F-1 visas who are seeking postgraduate training opportunities. Methods A 2-phase review of all US-based postgraduate year 1 (PGY1) residency and fellowship programs was conducted. In phase 1, program eligibility criteria were reviewed from the residency and fellowship directories published by the American Society of Health-System Pharmacists (ASHP) and American College of Clinical Pharmacy (ACCP). In phase 2, the postgraduate programs' official websites were reviewed for additional information. Each program was evaluated to determine the eligibility of international students with F-1 visa or Optional Practical Training (OPT) status, visa sponsorship and work authorization opportunities, and citizenship requirements. Programs were classified as eligible or noneligible to international students or as not providing sufficient information. Descriptive statistics were used to summarize the data. Results A total of 1,455 ASHP PGY1 programs and 69 fellowship programs were included in our analysis. In phase 1, there were 3 eligible programs accepting applicants with F-1/OPT status and 377 noneligible programs. In phase 2, there were 10 eligible programs accepting applicants with F-1/OPT status or providing H-1B sponsorship and 410 noneligible programs. Over 70% of programs (phase 1, n = 1,075; phase 2, n = 1,035) were classified as providing no information. None of the fellowship programs were classified as eligible in our review. Conclusion Most residency and fellowship programs did not provide clear eligibility criteria for students with F-1/OPT status. Only a few programs clearly stated that they would accept applicants with F-1/OPT status or provide visa sponsorship to graduates holding F-1 visas. [ABSTRACT FROM AUTHOR]

Objective: To determine the direct medical costs of treating lower respiratory tract infections (LRTIs) in a managed care organization (MCO)., Study Design: Retrospective analysis of a regional MCO identifying adults diagnosed with acute exacerbation of chronic bronchitis (AECB) or community- acquired pneumonia (CAP)., Methods: A claims database examination of International Classification of Diseases, Ninth Revision, Clinical Modification codes was conducted to identify adults receiving initial outpatient care for an LRTI during 2005-2006. Medical record review then was conducted to verify clinical diagnosis of AECB or CAP. Clinical and demographic data were collected. Outpatient office and clinic visits, hospitalization, and radiology, pathology, and pharmacy records were used to determine treatment costs. Treatment failure was determined by use of a second antibiotic course, follow-up emergency room presentation, or hospitalization for LRTI within 28 days of the index visit. The primary outcome was per-case treatment cost from the payer perspective., Results: Clinical diagnosis was confirmed for 65 unique coded visits (60 patients; 39 with AECB, 22 with CAP; 1 in both cohorts). Initial visit, initial diagnostic testing, and subsequent hospitalization accounted for the majority (63%) of payer costs. Antibiotics were responsible for 15% of payer costs. Higher initial antibiotic expenditure in the AECB cohort yielded a cost-benefit ratio of 3:1. Mean per-case costs for success and failure were $277 & $372 for AECB, and $493 & $3019 for CAP, respectively., Conclusions: Initial visit and hospitalization costs contribute the majority of payer expenditure while antibiotic expenditure incurs a nominal burden. Higher expenditure on initial antibiotic therapy in the AECB population appears to be beneficial.