Studies have been conducted to assess patient satisfaction with compounded pharmaceuticals and to directly compare compounded pharmaceuticals with their comparable commercial pharmaceuticals. Yet, the economic value of or potential for economic value derived from compounded pharmaceuticals relative to commercial pharmaceuticals is still not known. Therefore, the purpose of this study was to assess and compare compounding and non-compounding pharmacists' perceptions of the economic value of compounded preparations relative to commercial products. In-depth interviews with 10 compounding pharmacists and physicians who prescribe compounded prescription pharmaceutical preparations were conducted to help develop a self-administered questionnaire distributed to 50 compounding and 50 non-compounding pharmacists. Compounding and non-compounding pharmacists' perceptions differed most often in the context of compounded pharmaceuticals for pediatric patients. However, both groups responded with moderate agreement that compounded prescription treatments are more profitable for the pharmacy than commercial prescription treatments in most therapeutic areas. This research sought to understand the perception of pharmacists of areas for potential direct and indirect economic cost savings as a result of compounding. For all items whereby compounding and non-compounding pharmacists' ratings were significantly different, compounding pharmacists more strongly believed that compounding pharmaceuticals offered benefit and vice versa. The differences in ratings that were most common were those that directly compared the economic value of compounding and commercial pharmaceuticals, with compounding pharmacists more strongly agreeing with the potential cost savings associated with compounded pharmaceuticals. Based on these findings, prescription compounds are believed to have a benefit to the health system by those who provide them. Future research should proactively explore the economic benefit of compounded preparations compared to conventionally manufactured products to determine the economic value of compounded pharmaceuticals for patients, pharmacies, physicians, and the healthcare system.

The effect of symbols on conveying health information has been studied in a variety of contexts and populations. This investigation assessed whether short-term recall of prescription medication information could be enhanced in a low health literate population through the use of symbols. Participants recruited from various nonpharmacy educational service locations were randomly assigned to receive a prescription medication information leaflet in either a text-only, text with symbols, or symbols-only format and then administered the Rapid Estimate of Adult Literacy in Medicine (REALM). Only those with REALM scores indicative of a sixth grade or lower reading level were included in data analysis. An 8-item, interviewer-administered questionnaire was used to assess participants' recall of information contained in the leaflet. A fictitious medication was used to control for participants' past experiences with medications. Results of statistical testing revealed that the three groups did not differ with respect to their ability to recall the medication information, F(2, 157) = 0.943, p = .392. The symbols used in this investigation were not found to enhance the short-term recall of the medication information presented. These findings should not be considered a wholesale indictment of the use of symbols within health care and in pharmacies. Rather, they should serve as a caution to their widespread use without careful consideration.

Pharmacy leadership has many definitions, but on a basic level, it is continually improving the way pharmacy services are delivered so that patients benefit fully from the pharmacist's expertise. This pharmacy service evolution has progressed from primarily compounding to medication therapy management, with specialization in areas such as anticoagulation, diabetes, hypertension, and pain management. Along the way, services such as patient profiles, putting the name of the medication on the patient's label, generic product selection, making intravenous admixtures, unit–dose packaging/automated cabinets, clinical pharmacy, and computerization have been developed and implemented but not without resistance and obstacles that needed to be overcome by leadership. These changes required not only the formal Big L leaders (e.g., store managers, directors) but every pharmacist as a Little L leader to see these unmet medication needs and innovate systems to meet them. For this service evolution to continue on behalf of patients, leadership qualities must be developed in every pharmacist.

OBJECTIVES:To identify predictors of nonadherence to angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin II receptor blockers (ARBs) and to assess the association between nonadherence to ACEIs/ARBs and potentially avoidable hospitalizations (PAHs) among elderly high-risk patients with diabetes.METHODS:Medicare Part D enrollees from six states who had diabetes and coexisting hypertension and/or renal disease, were aged 65 years or older, and who had filled at least one prescription for ACEIs/ARBs in the first 6 months of 2006 were included in this retrospective cohort study. The primary outcomes of interests were patient nonadherence to ACEI/ARB therapy, which was defined as a proportion of days covered (PDC) less than 0.8 and PAH for diabetes during the patient follow-up period (July 1, 2006, to March 31, 2007).RESULTS:A total of 599,141 patients (mean [+/-SD] age 75.6 +/-7.3 years, 66% women, 63% white, 15% black, and 9% Hispanic) were included. Among them, 46% were nonadherent to ACEI/ARB therapy and 6.3% had a PAH during the follow-up period. In multivariate logistic regressions, patients with diabetes and both hypertension and renal disease and patients with diabetes and renal disease only were 24% and 15% more likely, respectively, to be nonadherent to ACEI/ARB therapy compared with patients with diabetes and hypertension. Black and Hispanic patients were also more likely to be nonadherent to ACEI/ARB therapy. Nonadherence to ACEI/ARB therapy was associated with a 5% increase in the likelihood of PAH.CONCLUSION:Adherence to ACEI/ARB therapy is suboptimal among elderly high-risk patients with diabetes enrolled in Medicare Part D programs from six states, and nonadherence to ACEIs/ARBs is associated with a slightly increased risk for PAH.

Diabetes patients with hypertension and/or renal disease are at an increased risk of cardiovascular morbidity and mortality. Clinical evidence suggests that the use of ACEI/ARB for these patients improves patient outcomes.

Objectives. To adapt and evaluate an instrument that measures perceived psychological contract violations in pharmacy students by schools and colleges of pharmacy.Design. A psychological contract violations measure was developed from existing literature and the 1997 ACPE Guidelines and pilot-tested with second-year pharmacy students at 2 schools of pharmacy. A revised measure then was administered to second-year pharmacy students at 6 schools of pharmacy. Using a 5-point Likert-type scale, participants were asked to indicate the level of obligations they received compared to what was promised by the school of pharmacy.Results. Exploratory factor analysis on the psychological contract violations measure was conducted using principal components analysis resulting in 7 factors, which led to a revised measure with 26 items. Using a sample of 339 students, the proposed 7-factor measurement model was tested using confirmatory factor analysis. In general, the results supported the hypothesized model. The final 23-item scale demonstrated both reliability and validity. Some students perceived certain aspects of the psychological contract that exists with their school of pharmacy were being violated.Conclusion. The psychological contract violations measure may serve as a valuable tool in helping to identify areas where their students believe that schools/colleges of pharmacy have not fulfilled promised obligations.

Objectives: This study examined the prevalence of nonadherence with oral hypoglycemic agents, antihypertensive drugs (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]), and statin medications among Medicare Part D enrollees with diabetes and analyzed the potential demographic and clinical factors that predict medication nonadherence. Methods: This was a retrospective cohort study of Medicare Part D enrollees with diabetes from 6 states (Alabama, California, Florida, Mississippi, New York, and Ohio). Adherence was calculated as the proportion of days covered (PDC; number of days with medication on hand/number of days in the specified time interval). A PDC was derived for each of the 3 categories of medications for patients who had at least 1 claim for the same class of medication. A comorbidity measure was created for each beneficiary using the Deyoadapted Charlson Comorbidity Index (CCI). Associations between nonadherence and patient characteristics including age, sex, race/ethnicity, and Deyo-adapted CCI were examined. Logistic regression models were constructed to identify predictors of nonadherence. Results: The study included 1,888,682 patients with diabetes. The mean (SD) age was 71.6 (11.6) years, and 59.5% (1,123,220/1,888,682) were female. A total of 66.4% (1,254,538/1,888,682) were white, 16.3% (308,158/1,888,682) were black, and 7.8% (147,498/1,888,682) were Hispanic. Estimated rates of non-adherence for oral hypoglycemic agents, ACEIs/ARBs, and statins were 35.1% (386,666/1,101,533), 41.8% (449,561/1,075,285), and 46.4% (447,106/962,877), respectively. In unadjusted analyses, patients aged <65 years, women, black or Hispanic patients, and patients with higher Deyo-adapted CCI were more likely to be nonadherent to all 3 classes of medications. The results were consistent in multivariate analyses, and all results were statistically significant at P < 0.001. Conclusions: In this study of Medicare Part D enrollees with diabetes, patients aged <65 years, women, black or Hispanic patients, and those with higher comorbidity scores were more likely to be nonadherent to medications. Interventions should be developed to improve medication adherence among these subgroups so that patients can achieve the full benefits of prescribed pharmacologic therapies.

s A107 with target drugs. The purpose of this study was to ascertain whether revocation of the PA requirement resulted in inferior rates of HbA1C testing amongst new users of these drugs. METHODS: Data on of new users of the target drugs and on HbA1C testing in these patients was extracted from EPR databases for the six-month postrevocation period. The proportion of patients who performed at least one HbA1C test during the four months prior to initiation of treatment and 95% confi dence intervals were calculated. The data were stratifi ed by month to detect possible trends in rates of testing during the post policy-change period. RESULTS: After rescinding the PA requirement, HbA1C testing amongst incident users of the target drugs dropped from 100% during the PA period to rates of 85.6% (95% CI 79.7, 91.5) to 94.4% (95% CI 90.8, 97.9). Statistically signifi cant variance in monthly rates of testing was not observed. CONCLUSIONS: The PA requirement resulted in total performance of a lab test necessary to monitor drug-therapy outcomes in diabetic patients. When PA is implemented as a quality-assurance strategy, revocation should be accompanied by continuing-education efforts to maintain adherence to recommendations for appropriate care. PDB53 SHORT-TERM OUTCOMES FOR AN EMPLOYER SPONSERED PHARMACISTPROVIDED MULTI CENTER DIABETES MANAGEMENT PROGRAM

Conclusions Some divergence exists between administrators' expectations and that of faculty. Administrators recognize the need to engage and reward productive faculty, but currently, limited financial resources restrict their ability to do so monetarily.

BACKGROUND:Direct-to-consumer advertising (DTCA) has an influence on patients' perceptions, awareness, and behaviors. Inoculation theory and the model of belief processing provide insights into cognition that stand to increase our understanding of how patients process the information presented in these advertisements and form beliefs about medications.OBJECTIVE:This study was conducted to evaluate the effect of sidedness of appeals and argument types in understanding beliefs that are formed after exposure to advertisements. DTCA and negative experiences were used to study these constructs.METHODS:A 2 (1-sided vs 2-sided appeals) x 2 (causal vs authoritative arguments) factorial study design was used. A total of 263 undergraduate students were assigned to view 1 of the 4 mock flu-medication advertisements and complete a questionnaire. Subjects were then presented with a negative scenario and were asked to fill out a questionnaire based on the information in the ad and in the negative scenario. The dependent measures included belief change, change in intent to inquire, and standardized price change. Data were analyzed using 2-way analysis of variance.RESULTS:Subjects exposed to 2-sided appeals showed lower belief change, standardized price change, and change in intent to inquire following a negative experience than subjects exposed to 1-sided appeals (P<.05). No significant difference was found between subjects who received causal arguments and those who received authoritative arguments. A significant interaction effect was observed between sidedness of appeal and argument type on initial belief and initial intent to inquire.CONCLUSIONS:Some support for aspects of inoculation theory and theory of belief formation was found. The findings suggest that complying with the "fair-balance" requirement may be beneficial to pharmaceutical marketers as 2-sided appeals increase the tenacity of consumers' beliefs. Higher initial belief and intent to inquire when causal arguments are used in 2-sided promotional messages suggest that use of data to substantiate claims in advertisements may result in enhanced beliefs about the merits of advertised medication.

ABSTRACTThis project evaluated the predictive capabilities of a school of origin variable over and above the predictive capabilities of a model including pre-pharmacy math/science GPA, PCAT, and prior degree variables. Evaluating 6 years of pharmacy student admission and progression data from 1997 to 2002, the project explored a variable that designated the location where a majority of the pre-pharmacy course work was completed, either a 2-year or 4-year school. The regression models found that a school of origin variable contributed significantly to the predictive model of GPA and PCAT and accounted for more variance than prior degree in the prediction of first-semester and first-year pharmacy-student GPA. Defining a school of origin variable based upon the location of completion of the majority of pre-pharmacy course work aids in the prediction of first-year pharmacy students' academic performance in addition to a traditional model of PCAT and GPA and prior degree.

OBJECTIVESTo determine the value of employing the Learning and Study Strategies Inventory (LASSI), Defining Issues Test (DIT), and Watson-Glaser Critical Thinking Appraisal (WGCTA) in predictive models for first-year pharmacy student academic performance.METHODSSix years of pharmacy student admission and progression data were evaluated. Additional predictive validity offered by these variables over a model of prepharmacy grade point average and pharmacy college admission test (PCAT) score was examined.RESULTSNone of the 3 measures offered the ability to predict first-semester or first-year academic performance over and above GPA and PCAT.CONCLUSIONSThe LASSI, DIT, and WGCTA do not appear to assess abilities that are directly related to academic performance; however, these instruments may be useful in assessing other student attributes that are highly desirable for the practice of pharmacy.