Analysis of 10-year income trends for pharmacists and other select health professionals

DISCLAIMER

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PURPOSE

To evaluate income trends among pharmacists and other select health professions (dentists, nurse practitioners, registered nurses, and physicians) in the US for the 10-year period of 2012 to 2021, with special attention given to the first 2 years of the COVID-19 pandemic (2020 and 2021).

METHODS

A retrospective analysis was conducted of 2012 to 2021 income data for select health professions, collected from the American Community Survey. Univariate time series analysis was conducted using exponential smoothing to examine income patterns over the 10-year study period and forecast income for the next 5-year period (2022 to 2026) for each health profession. Additionally, time series regression models were constructed for each health profession. Descriptive statistics (mean percent change in income and SD) were calculated for each health profession for the prepandemic era (2012 to 2019) and the first 2 years of the pandemic (2020 and 2021).

RESULTS

Goodness-of-fit statistics for each forecast model indicate highly accurate forecasts. The model for each health profession indicates a significant positive trajectory in income (P < 0.001), although pharmacists are projected to have a lower rate of income growth among the 5 health professions for the next 5-year period, 2022 to 2026. During the first 2 years of the pandemic, pharmacists had the lowest mean percent change in income (mean, 2.0%; SD, 2.0%) among the 5 health professions.

CONCLUSION

Growth in pharmacist income is projected to lag behind that in other health professions in the near future. Individual-, organization-, and profession-level strategies may facilitate opportunities for income growth among pharmacists.

Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study

Background

Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias.

Objectives

This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias.

Methods

This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities.

Results

Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99).

Discussion

The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias.

Conclusions

Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.

ASHP and ASHP Foundation Pharmacy Forecast 2024: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems

Purpose: The 2024 ASHP Pharmacy Forecast identifies and contextualizes emerging issues and trends that will influence healthcare, health systems, and the pharmacy profession and provides recommendations to inform long-term strategic planning that should prompt action by pharmacists and health-system leaders. Methods: Drawing on the “wisdom of crowds” concept, a survey was constructed with 6 general themes, each with 6 to 9 focused statements and a seventh theme on preparedness (58 survey items in total). The size of and representation within the survey panel were intended to capture opinions from a wide range of pharmacy leaders. The survey instructed panelists to consider the likelihood of the events/scenarios described in the statements occurring in the next 5 years as being likely, somewhat likely, somewhat unlikely, or very unlikely. Then, survey panelists assessed the preparedness (from very unprepared to very prepared) for 12 of the statements. Results: The 6 survey themes identified were Urgent Public Health Priorities, Responding to the Mental Health Crisis, Achieving Care Equity, New Disease Paradigms and Treatment Innovations, Workforce: Focus on Culture for the Future, and Artificial Intelligence: Can Ethics and Regulators Catch Up? The survey was completed by 250 respondents, yielding an 88% response rate. Analysis of survey results was provided by chapter authors along with strategic recommendations to guide actions for each theme. Conclusion: The focus of the Pharmacy Forecast is on large-scale, long-term trends that will influence healthcare and the pharmacy profession over months and years and not on day-to-day situational dynamics. The report provides insight to stimulate thinking and discussion and provides a starting point to proactively position leaders, their teams, and departments for potential future events and trends.

Solving racial/ethnic disparities associated with Medicare Part D Star Ratings

OBJECTIVE

Medicare Part D Star Ratings are instrumental in shaping healthcare quality improvement efforts. However, the calculation metrics for medication performance measures for this program have been associated with racial/ethnic disparities. In this study, we aimed to explore whether an alternative program, named Star Plus by us that included all medication performance measures developed by Pharmacy Quality Alliance and applicable to our study population, would reduce such disparities among Medicare beneficiaries with diabetes, hypertension, and/or hyperlipidemia.

METHOD

We conducted an analysis of a 10% random sample of Medicare A/B/D claims linked to the Area Health Resources File. Multivariate logistic regressions with minority dummy variables were used to examine racial/ethnic disparities in measure calculations of Star Ratings and Star Plus, respectively.

RESULTS

Adjusted results indicated that relative to non-Hispanic Whites (Whites), racial/ethnic minorities had significantly lower odds of being included in the Star Ratings measure calculations: the odds ratios (ORs) for Blacks, Hispanics, Asians, and Others were 0.68 (95% confidence interval [CI] = 0.66-0.71), 0.73 (CI = 0.69-0.78), 0.88 (CI = 0.82-0.93), and 0.92 (CI = 0.88-0.97), respectively. In contrast, every beneficiary in the sample was included in Star Plus. Further, racial/ethnic minorities had significantly higher increase in the odds of being included in measure calculation in Star Plus than Star Ratings. The ORs for Blacks, Hispanics, Asians, and Others were 1.47 (CI = 1.41-1.52), 1.37 (CI = 1.29-1.45), 1.14 (CI = 1.07-1.22), and 1.09 (CI = 1.03-1.14), respectively.

CONCLUSIONS

Our study demonstrated that racial/ethnic disparities may be eliminated by including additional medication performance measures to Star Ratings.

Racial and ethnic disparities in the enrolment of medicare medication therapy management programs

Objectives

Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data.

Methods

Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017.

Key Findings

Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81).

Conclusions

Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.

Cost-Effectiveness of Medication Therapy Management Program Across Racial and Ethnic Groups Among Medicare Beneficiaries

OBJECTIVES

Equity and effectiveness of the medication therapy management (MTM) program in Medicare has been a policy focus since its inception. The objective of this study was to evaluate the cost-effectiveness of the Medicare MTM program in improving medication utilization quality across racial and ethnic groups.

METHODS

This study analyzed 2017 Medicare data linked to the Area Health Recourses File. A propensity score was used to match MTM enrollees and nonenrollees, and an incremental cost-effectiveness ratio between the 2 groups was calculated. Effectiveness was measured as the proportion of appropriate medication utilization based on medication utilization measures developed by Pharmacy Quality Alliance. Net monetary benefits were compared across racial and ethnic groups at various societal willingness-to-pay (WTP) thresholds. The 95% confidence intervals were obtained by nonparametric bootstrapping.

RESULTS

MTM dominated non-MTM among the total sample (N = 699 992), as MTM enrollees had lower healthcare costs ($31 135.89 vs $32 696.69) and higher proportions of appropriate medication utilization (87.47% vs 85.31%) than nonenrollees. MTM enrollees had both lower medication costs ($10 681.21 vs $11 003.08) and medical costs ($20 454.68 vs $21 693.61) compared with nonenrollees. The cost-effectiveness of MTM was higher among Black patients than White patients across the WTP thresholds. For instance, at a WTP of $3006 per percentage point increase in effectiveness, the net monetary benefit for Black patients was greater than White patients by $2334.57 (95% confidence interval $1606.53-$3028.85).

CONCLUSIONS

MTM is cost-effective in improving medication utilization quality among Medicare beneficiaries and can potentially reduce disparities between Black and White patients. Expansion of the current MTM program could maximize these benefits.

Racial and ethnic disparities in Medicare Part D medication therapy management services utilization

Background

The Medicare Part D medication therapy management (MTM) program has positive effects on medication and health service utilization. However, little is known about its utilization, much less so about the use among racial and ethnic minorities.

Objective

To examine MTM service utilization among older Medicare beneficiaries and to identify any racial and ethnic disparity patterns.

Methods

A retrospective cross-sectional analysis of 2017 Medicare administrative data, linked to the Area Health Resources Files. Fourteen outcomes related to MTM service nature, initiation, quantity, and delivery were examined using logistic, negative binomial, and Cox proportional hazards regression models.

Results

Racial and ethnic disparities were found with varying patterns across outcomes. For example, compared with White patients, the odds of opting out of MTM were 8% higher for Black patients (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.03-1.14), 57% higher for Hispanic patients (OR = 1.57, 95% CI = 1.42-1.72), and 57% higher for Asian patients (OR = 1.57, 95% CI = 1.33-1.85). The odds of continuing MTM from the previous years were 12% lower for Black patients (OR = 0.88, 95% CI = 0.86-0.90) and 3% lower for other patients (OR = 0.97, 95% CI = 0.95-0.99). In addition, the probability of being offered a comprehensive medication review (CMR) after MTM enrollment was 9% lower for Hispanic patients (hazard ratio [HR] = 0.91, 95% CI = 0.85-0.97), 9% lower for Asian patients (HR = 0.91, 95% CI = 0.87-0.94), and 3% lower for other patients (HR = 0.97, 95% CI = 0.95-0.99). Hispanic and Asian patients were more likely to have someone other than themselves receive a CMR.

Conclusions

Racial and ethnic disparities in MTM service utilization were identified. Although the disparities in specific utilization outcomes vary across racial/ethnic groups, it is evident that these disparities exist and may result in vulnerable communities not fully benefiting from the MTM services. Causes of the disparities should be explored to inform future reform of the Medicare Part D MTM program.

A diversity index to measure underrepresented minority enrollment in United States colleges and schools of pharmacy

INTRODUCTION

With an underrepresented minority (URM) student population of <20%, colleges and schools of pharmacy (CoPs) in the United States (US) lag behind the national population, in which URMs account for >30%. Few tools are available to assist the >140 US CoPs in tracking progress in URM diversity among student pharmacists. Thus, the study's purpose was to address this gap by: (1) creating a "diversity index" for pharmacy programs; and (2) determining changes in diversity index scores between 2011 and 2020.

METHODS

This was a secondary analysis of 2011-2020 fall URM enrollment data for CoPs and national and state population data. The annual diversity index score for 2011-2020 was calculated for each CoP. Wilcoxon signed-rank tests and Mann-Whitney U tests were conducted.

RESULTS

Among all CoPs, median URM percent enrollment significantly increased from 7.7% in 2011 to 14.5% in 2020. Median diversity index scores for all CoPs increased from 0.66 in 2011 to 0.76 in 2020, but this change was not statistically significant. Historically Black Colleges and Universities (HBCUs) and Hispanic-Serving Institutions (HSIs) had significantly greater diversity index scores than non-HBCUs/HSIs. Diversity index scores of public vs. private colleges did not differ significantly.

CONCLUSION

This diversity index represents an important step in tracking progress in increasing URM student pharmacist representation in CoPs. The index may be utilized as a tool to support development of diversity best practices and more inclusive environments for student pharmacists, faculty, staff, and stakeholders.

Examining Preparatory Testing and Other Factors Associated With Performance on the Multistate Pharmacy Jurisprudence Examination

Objective. To evaluate whether the score on the Pre-Multistate Pharmacy Jurisprudence Examination (Pre-MPJE) predicts pharmacy students' performance on the MPJE, and to determine whether demographics, pre-pharmacy school factors, or pharmacy school factors affect MPJE outcomes.Methods. We performed a retrospective review of pharmacy school graduates' (N = 156) MPJE scores, Pre-MPJE scores, demographics, pre-pharmacy school academic performance factors, and pharmacy school academic performance factors. Bivariate and correlational analyses were conducted along with multiple linear regression models to determine the influence of variables on the MPJE total scaled score.Results. A total of 136 pharmacy school graduates were included, with most being female (59%) and non-Hispanic White students (75%). The score on the Pre-MPJE was not significantly correlated with students' first-attempt MPJE pass-fail outcome or total scaled score. Factors that were correlated with passing the MPJE were a younger age at graduation, a higher pharmacy law course grade, Pharmacy Curriculum Outcomes Assessment (PCOA) examination scores, specifically scaled total scores and scaled scores for content areas 1-4 and final pharmacy school grade point average (GPA). The MPJE total scaled score was correlated with a higher pre-pharmacy school GPA, pharmacy law course grade, PCOA total and content area 1-4 scaled scores, and final pharmacy school GPA. However, regression models found that the greatest variance in MPJE total scaled score was contributed by the pharmacy law course grade. The total scaled score on the PCOA contributed to some variance for all MPJE takers, but only the pharmacy law course grade significantly influenced the in-state MPJE total scaled score.Conclusion. The findings did not show that the Pre-MPJE score was a predictor for passing the MPJE or for the MPJE total scaled score. The most important determinant of the MPJE total scaled score was a student's performance in the pharmacy law course.

Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer's disease and related dementias

OBJECTIVE

Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD).

METHODS

Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017.

RESULTS

In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD.

CONCLUSIONS

Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.

Racial and ethnic disparities due to Medicare Part D Star Ratings criteria among kidney transplant patients with diabetes, hypertension, and/or dyslipidemia

BACKGROUND: Policies such as Medicare Part D Star Ratings are designed to encourage medication adherence and facilitate positive health outcomes. Patients who have received a kidney transplant not included in assessment of Star Ratings measures may have worse outcomes. OBJECTIVE: To determine if criteria for inclusion in assessment of Star Ratings medication adherence measures among kidney transplant patients with diabetes, hypertension, and dyslipidemia lead to racial and ethnic disparities in who is included in this assessment. METHODS: This was a cross-sectional, secondary analysis of 94,822 adult kidney transplant patients receiving continuous coverage of Medicare Parts A/B/D and filling at least 1 prescription for diabetes, hypertension, or dyslipidemia in 2017. Utilizing 2017 Medicare claims, inclusion in assessment of Star Ratings measures was determined based on criteria for each measure concerning adherence to oral diabetes, hypertension, and dyslipidemia medication. Binary and multinomial logistic regression were conducted. RESULTS: Among kidney transplant patients with diabetes only, Black and Hispanic patients were less likely than White patients to be included in assessment of the Star Ratings adherence measure for oral diabetes medications (P < 0.0001). Among kidney transplant patients with hypertension only and dyslipidemia only, all racial and ethnic minority groups were less likely to be included in assessments of Star Ratings adherence measures for oral hypertension and dyslipidemia medications (P < 0.001). For example, among patients with hypertension, adjusted odds ratios for inclusion of Black, Hispanic, and Asian patients were 0.44 (95% CI = 0.40-0.49), 0.56 (95% CI = 0.49-0.63), and 0.55 (95% = CI 0.45-0.67), respectively. CONCLUSIONS: Disparities exist among patients who have received a kidney transplant qualifying for inclusion in Star Ratings measures, which may ultimately facilitate adverse health outcomes. DISCLOSURES: Marie Chisholm-Burns is a member of the American Society of Transplantation Board of Directors. Christina Spivey has no conflicts of interest to disclose. Chi Chun Tsang has no conflicts of interest to disclose. Junling Wang received funding for this project from the National Institute on Aging/National Institutes of Health; she has also received funding from AbbVie and Pharmaceutical Research and Manufacturers of America (additionally, she has received consulting fees from the latter). Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG049696 (Principal Investigator: Junling Wang). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsor of the research does not have any role in any aspect of the research, including study design and the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the manuscript for publication.

The Lean Six Sigma Define, Measure, Analyze, Implement, Control (LSS DMAIC) Framework: An Innovative Strategy for Quality Improvement of Pharmacist Vaccine Recommendations in Community Pharmacy

Community pharmacies represent a highly accessible and convenient setting for vaccination. However, setting-specific barriers exist which contribute to suboptimal vaccination rates, particularly for pneumococcal vaccinations. One proven quality improvement framework growing in use within healthcare settings is Lean Six Sigma (LSS). This paper describes the application of the LSS framework in select locations of a national pharmacy chain. The implementation of a training program for improved recommendation techniques to promote higher rates of pneumococcal vaccinations in high-risk adult populations is also addressed. A mixed-methods approach including pre/post quasi-experimental design and in-depth key informant interviews was used.

Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer's Disease: an observational analysis

Background

Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population.

Methods

This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference).

Results

The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant.

Conclusions

Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.

Developing a Framework of Relationships Among Noncognitive Factors in Doctor of Pharmacy Students' Academic Performance

Objective. To develop a framework of the effects of select noncognitive factors (grit, perceived stress, internal locus of control, and select Big Five personality traits) on pharmacy students' academic performance.Methods. A survey measuring select noncognitive factors was administered to two cohorts of first professional year (P1) pharmacy students (entering classes of 2019 and 2020, n=374) during fall orientation. Demographics, pre-pharmacy GPA, and P1 fall semester GPA were collected from student records. Structural equation modeling was conducted to assess the proposed framework.Results. Academic performance was directly influenced by students' (n=367; 98.1%) perceived stress and neuroticism and indirectly influenced by internal locus of control and neuroticism (via perceived stress as mediator). Neuroticism has a complex relationship in the models as it was directly and positively associated with academic performance, and indirectly contributed to decreased academic performance via a positive association with perceived stress. Squared multiple correlations indicated 13% and 9% of the variance in academic performance in the first final model (academic performance measured by pre-pharmacy GPA and P1 fall GPA) and second final model (academic performance measured by P1 fall GPA), respectively, were explained by the predictor variables.Conclusion. Evidence provided by structural equation modeling supports the conclusion that select noncognitive factors, namely perceived stress, neuroticism, and internal locus of control, have direct and indirect effects on the academic success of P1 students. The model variances of 9% and 13% represent 36% to 52% of the predictive value of the most accepted cognitive measures used to determine students' potential for academic success.

Systematic review of noncognitive factors influence on health professions students' academic performance

Increased importance has been placed on noncognitive skills in professional development and by accrediting bodies of health professions programs in recent years. Therefore, the purpose of this study was to conduct a comprehensive systematic review of evidence examining effects of academic resilience, grit, perceived stress, locus of control, and Big Five Personality Traits on academic performance of health professions students. A literature search of peer-reviewed, English-language articles describing select noncognitive factors was performed using seven databases. Searches were performed from the earliest index date through May 2020. The following data from included studies were extracted and summarized: research design hierarchy, hierarchy of study outcomes (modified from Kirkpatrick), association between noncognitive factors and academic outcomes, and quality assessment criteria. 149 articles met inclusion criteria. Almost 80% of studies were Level III (observational). Medical students were the most frequently studied population (n = 73 articles). The most studied academic outcome was grade point average (n = 61). Perceived stress and Big Five Personality Traits accounted for greater than 50% of studies. Most studies were rated as fair to good quality. Associations between noncognitive factors and academic outcomes were largely inconsistent, although greater perceived stress was generally associated with poorer academic performance outcomes, while higher conscientiousness, academic resilience, and grit were generally associated with better outcomes. This systematic review represents a large body of evidence concerning select noncognitive factors and their association with academic performance of health professions students. Support services addressing noncognitive factors should be deliberated and tailored for specific health professions education programs and student populations.

Leadership lessons from administrators, faculty, and students during the COVID-19 pandemic

INTRODUCTION

Due to the largescale scope of the COVID-19 pandemic, strain on the higher education system in the United States has been extraordinary. Yet, with any crisis, there is the opportunity to learn, grow, and develop new knowledge and strategies to benefit educational programs moving forward. The purpose of this study is to describe the leadership lessons learned by academic pharmacy during the COVID-19 pandemic from the perspective of administrators, faculty, and students.

METHODS

A retrospective analysis was performed of qualitative data provided by three focus groups. Each focus group was composed of one of three distinct college of pharmacy constituencies: (1) members of the college's executive team, (2) faculty members who currently or in the recent past served in college leadership positions, and (3) students in an elective pharmacy leadership course. Focus groups were semi-structured, and discussion concerned leadership lessons learned from the COVID-19 pandemic. A modified form of inductive content analysis and abstraction was used to assess qualitative data collected during the focus groups.

RESULTS

Five main themes emerged across all three focus groups, which include open and ongoing communication, staying connected, turning crisis into opportunity, being adaptable/flexible, and finding ways to stay productive. Themes unique to each focus group were also identified.

CONCLUSIONS

Core leadership lessons in emergent situations like the COVID-19 pandemic, including adaptability to the changing environment and communicating accurately and with appropriate frequency, illustrate the need for flexibility during times of crisis and highlight areas of focus for future planning.

Effects of peer-led study sessions on first-year student pharmacist performance in pharmacy math

INTRODUCTION

To evaluate effects of peer-led study sessions on performance in a traditionally challenging course, Pharmacy Math, among first-year student pharmacists (P1s).

METHODS

Peer-led study sessions were conducted throughout fall 2019 for P1s. Sessions were led by two second-year student pharmacists and focused on study skills and course-related strategies, principles, and content. P1s who attended the majority (at least five) of study sessions were compared to those who attended fewer sessions on student demographics, undergraduate science grade point average, and course outcome (pass/did not pass) using chi-square and independent samples t-tests. Relative risk (RR) was calculated. A sub-analysis of students considered at risk of failing was also conducted.

RESULTS

There were 200 P1 participants. Twenty-four students (12%) attended the majority of the sessions and 176 students (88%) attended fewer sessions. Of the 24 students who attended ≥ five study sessions, all passed Pharmacy Math, while 12 of the 176 students who attended fewer sessions failed Pharmacy Math. Students who attended ≥ five sessions had a 6.8% reduction in risk of failing compared to students who attended fewer sessions (RR = 0.93, 95% CI = 0.895, 0.97). More striking, at-risk students who attended ≥ five study sessions had a 17.1% reduction in risk of failing.

CONCLUSIONS

Peer-led study sessions contribute to reduced risk of failing Pharmacy Math among students who attend a majority of study sessions. Improvements for the future were identified, including mandatory attendance, group structure, and creative ways to cover concepts.

Effects of the Medicare Part D comprehensive medication review on medication adherence among patients with Alzheimer's disease

OBJECTIVE

Older patients with Alzheimer's disease (AD) are challenged with adhering to complex medication regimens. We examined effects of Comprehensive Medication Review (CMR), a required Medicare Part D Medication Therapy Management (MTM) program component, on medication adherence among AD patients.

METHODS

This retrospective study analyzed 100% of 2016-2017 Medicare claims covering the entire United States, linked to Area Health Resources Files. Medicare beneficiaries aged ≥65 years were included. Propensity score matching identified comparable intervention and comparison groups with the intervention defined as receiving a CMR in 2017. A difference-in-differences analysis included in multivariate logistic regressions an interaction term between CMR receipt and year 2017. The outcome measured was nonadherence to diabetes, hypertension and hyperlipidemia medications, with nonadherence defined as proportion of days covered <80% for study medications.

RESULTS

Unadjusted comparisons indicated the proportion of nonadherence for intervention group members decreased from 2016 to 2017 but increased for the comparison group. In adjusted analyses, reduction in medication nonadherence among the intervention group remained higher: odds ratios for the interaction term were 0.62 (95% confidence interval [CI] = 0.54-0.71), 0.54 (95% CI = 0.50-0.58) and 0.50 (95% CI = 0.47-0.53) respectively for diabetes, hypertension and hyperlipidemia medications. This suggests that the likelihood of nonadherence in the intervention group was respectively reduced by 38%, 46% and 50% more than the comparison group.

CONCLUSIONS

CMR was found to reduce nonadherence to diabetes, hypertension and hyperlipidemia medications among older Medicare beneficiaries with AD. This provides evidence that the MTM program is effective for a population with unique medication compliance challenges.

Effects of the Medicare Part D Comprehensive Medication Review on Racial and Ethnic Disparities in Medication Adherence

BACKGROUND

Substantial research has documented inequalities between US minorities and whites in meeting the eligibility criteria for the Medicare Part D medication therapy management (MTM) program. Even though the Centers for Medicare & Medicaid Services attempted to relax the eligibility criteria, a critical barrier to effective MTM reform is a lack of stronger evidence about the effects of MTM on minorities' health outcomes.

OBJECTIVE

To examine the effects of comprehensive medication review (CMR), an MTM core component, on racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years.

METHODS

This study used full-year 2017 Medicare Parts A, B, and D claims data, including MTM data, linked to the Area Health Resources Files. Racial and ethnic disparities in nonadherence to diabetes, hypertension, and hyperlipidemia medications were compared between CMR recipients and nonrecipients matched by their propensity scores. To determine the changes in racial and ethnic disparities after receiving CMR, a difference-in-differences framework was applied, by including in logistic regression analyses interaction terms between dummy variables for CMR receipt and each racial or ethnic minority group.

RESULTS

Compared with CMR nonrecipients, CMR recipients had significantly lower racial and ethnic disparities across the 3 outcome measures, with the exception of the difference between whites and blacks in nonadherence to diabetes medications. For example, compared with CMR nonrecipients, among CMR recipients the differences in the odds of nonadherence to hypertension medications were reduced, respectively, by 8% (95% confidence interval [CI], 0.88-0.96) between whites and blacks; by 18% (95% CI, 0.78-0.86) between whites and Hispanics; by 16% (95% CI, 0.77-0.91) between whites and Asians; and by 9% (95% CI, 0.85-0.98) between whites and other racial and ethnic groups.

CONCLUSION

Receiving a CMR reduced the racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. These findings provide critical empirical evidence that may inform the future design of the Medicare Part D MTM program, which is valuable for improving pharmacotherapy outcomes and could further realize its potential when additional people from racial and ethnic minorities are enrolled.

Resilience and First-Year Pharmacy Students' Academic Performance in a Pharmacy Math Course

Objective. The purpose of this study was to examine the relationship between academic resilience and academic success in Doctor of Pharmacy (PharmD) students.Methods. A cross-sectional survey using the Academic Pharmacy Resilience Scale (APRS-16) was conducted in two cohorts of first year pharmacy (P1) students (n = 374) during fall orientation in 2019 and 2020. The following data were also collected from student records: demographics, pre-pharmacy grade point average (GPA), Pharmacy Math outcome (passing or failing the course), and Pharmacy Math final numerical grade. Academic success was defined as achieving a passing grade in a Pharmacy Math course. Correlational, multiple logistic regression, and multiple linear regression analysis were conducted.Results. The survey response rate was 98.1%, and approximately 95% of participants passed Pharmacy Math. No significant correlations were found between Pharmacy Math final pass/fail outcome or Pharmacy Math final numerical grade and APRS-16 overall and subscale scores. In multiple logistic regression, neither pre-pharmacy GPA nor APRS overall scale or subscale scores were significantly associated with final Pharmacy Math outcome (passing/failing). In multiple linear regression, pre-pharmacy GPA was significantly associated with Pharmacy Math final numerical grade, but APRS-16 overall score and subscale scores were not.Conclusion. First-year pharmacy students' performance in Pharmacy Math was not influenced by academic resilience. Studies like this one examining the relationship between pharmacy students' resilience and academic performance are lacking. Future studies should assess whether academic resilience may affect performance in other courses as well as performance in the PharmD curriculum.

Exploring racial and ethnic disparities in medication adherence among Medicare comprehensive medication review recipients

Background

There has been a lack of evidence on whether there are racial and ethnic disparities in medication nonadherence among individuals receiving comprehensive medication review (CMR), a required component of the Medicare Part D medication therapy management (MTM) services.

Objectives

To explore racial/ethnic disparities in medication nonadherence among older MTM enrollees who received a CMR and to determine how much the identified disparities can be explained by observed characteristics.

Methods

The retrospective study used 100% of the 2017 Medicare claims, including MTM data. Linked Area Health Resources Files provided community characteristics. Nonadherence was defined as proportion of days covered <80%, and was measured for diabetes, hypertension, and hyperlipidemia medications. Racial/ethnic disparities were examined by logistic regressions that included racial/ethnic minority dummy variables. A nonlinear Blinder-Oaxaca decomposition method was applied to decompose the identified disparities.

Results

Compared with non-Hispanic Whites (Whites), Blacks were respectively 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.33–1.45), 27% (OR = 1.27, 95% CI = 1.22–1.32), and 43% (OR = 1.43, 95% CI = 1.39–1.47) more likely to be nonadherent to diabetes, hypertension, and hyperlipidemia medications; Hispanics were 20% (OR = 1.20, 95% CI = 1.14–1.27) more likely to be nonadherent to hyperlipidemia medications. The total portion of disparity explained was 13.42%, 7.66%, 14.87%, and 10.69% respectively for disparities in Black-White (B–W) diabetes, B–W hypertension, B–W hyperlipidemia, and Hispanic-White hyperlipidemia. The top three contributors were the proportion of married-couple families, census region, and male gender.

Conclusions

A lower level of community affluence and social support, regional variations, and a lower proportion of males in Blacks and Hispanics may contribute to the disparities in medication nonadherence. The large unexplained portion of the disparity attests that nonadherence is a complex issue. The Medicare MTM program needs to implement measures to reduce disparities in medication adherence.

•

This retrospective study used 100% of the 2017 Medicare claims including MTM data.

•

Racial/ethnic disparity in medication adherence was identified among CMR recipients.

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Blacks were more likely than Whites to be nonadherent to all medications studied.

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Hispanics were more likely than Whites to be hyperlipidemia medication nonadherent.

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Observed characteristics explained close to 15% of the identified disparity.

Racial/ethnic disparities in measure calculations for Part D Star Ratings among Medicare beneficiaries with diabetes, hypertension, and/or hyperlipidemia

BACKGROUND

Previous literature reported racial/ethnic disparities in the measure assessment of diabetes medication adherence in the Medicare Part D Star Ratings program.

OBJECTIVE

This study examined the likelihood of inclusion in measure calculation across racial/ethnic groups for adherence metrics in Part D Star Ratings among individuals with diabetes, hypertension, and/or hyperlipidemia.

METHODS

This was a retrospective cross sectional analysis of a 10% random sample of 2017 Medicare claims linked to Area Health Resources Files. Inclusion in measure calculation was determined based on inclusion/exclusion criteria in adherence metrics for adherence medications for diabetes, hypertension, and hyperlipidemia in Part D Star Ratings developed by the Pharmacy Quality Alliance. Logistic regression and multinomial logistic regression were used to adjust for patient/community characteristics.

RESULTS

The study sample size was 2 707 216. Compared to Non-Hispanic White (White) beneficiaries, minorities were more likely to be excluded from measure calculation among individuals with 1 condition. For example, among individuals with hypertension, compared to White individuals, the adjusted odds ratios for exclusion for Black, Hispanic, Asian/Pacific Islander and other individuals were 1.46 (95% confidence interval, or CI = 1.42-1.50), 1.38 (95% CI = 1.33-1.43), 1.28 (95% CI = 1.21-1.35), and 1.08 (95% CI = 1.02-1.15), respectively. Among individuals with more than 1 chronic condition, minorities were more likely to be included in fewer calculations for medication adherence measures. For example, among individuals with all 3 conditions, the adjusted relative risk ratios for Black, compared to White, beneficiaries for being included in 0, 1, and 2 measures, versus all 3 measures, were 2.14 (95% CI = 1.99-2.30), 1.49 (95% CI = 1.41-1.56), 1.20 (95% CI = 1.18-1.23), respectively.

CONCLUSIONS

Compared to White beneficiaries, racial/ethnic minorities are more likely to be excluded from the calculation for adherence measures among individuals with diabetes, hypertension, and/or hyperlipidemia. Future studies should examine whether such disparities exacerbate existing racial/ethnic disparities in health outcomes and devise solutions for these disparities.

Examination of the Relationship between Health-related Quality of Life and Academic Performance Among Student Pharmacists

INTRODUCTION

First-year student pharmacists (P1s) may experience a number of stressors that may affect academic performance due to the transition into a professional program. Study objectives were to evaluate student demographic and pre-pharmacy factors associated with perceived stress among P1s, analyze relative change in perceived stress over the P1 year, and assess associations between perceived stress and academic performance.

METHODS

The Perceived Stress Scale (PSS-10) was administered three times to P1s: during orientation, midpoint of fall semester, and midpoint of spring semester. Data were also collected using school records, including demographics, P1 fall grade point average (GPA), P1 spring GPA, and P1 year GPA. Paired-sample t-tests, independent samples t-tests, Analysis of Variance, correlational analysis, and multiple linear regression were conducted.

RESULTS

Of 202 P1s, 201 (99.5%) completed the orientation survey administration and 110 (54.5%) completed all three administrations. PSS-10 score significantly increased across survey administrations. Differences in PSS-10 scores at orientation were noted based on gender and race/ethnicity (P < .05), with female and minority students experiencing greater levels of stress. PSS-10 score (spring administration) was significantly, inversely correlated to P1 fall GPA, spring GPA, and year GPA (P < .05). Undergraduate science GPA, PSS-10 score (orientation administration), and age were included in the final version of the regression model as significant predictors of P1 year GPA.

CONCLUSIONS

Perceived stress increased over the P1 year, and higher perceived stress was associated with lower P1 academic performance. Future studies should examine strategies to assist P1s in managing stress.

Longitudinal examination of perceived stress and academic performance of first-year student pharmacists

INTRODUCTION

First-year pharmacy students (P1s) may experience a number of stressors that may affect academic performance due to the transition into a professional program. Study objectives were to evaluate student demographic and pre-pharmacy factors associated with perceived stress among P1s, analyze relative change in perceived stress over the P1 year, and assess associations between perceived stress and academic performance.

METHODS

The Perceived Stress Scale (PSS-10) was administered three times to P1s: during orientation, midpoint of fall semester, and midpoint of spring semester. Data were also collected using school records, including demographics, P1 fall grade point average (GPA), P1 spring GPA, and P1 year GPA. Paired-sample t-tests, independent samples t-tests, Analysis of Variance, correlational analysis, and multiple linear regression were conducted.

RESULTS

Of 202 P1s, 201 (99.5%) completed the orientation survey administration and 110 (54.5%) completed all three administrations. PSS-10 score significantly increased across survey administrations. Differences in PSS-10 scores at orientation were noted based on gender and race/ethnicity (P < .05), with female and minority students experiencing greater levels of stress. PSS-10 score (spring administration) was significantly, inversely correlated to P1 fall GPA, spring GPA, and year GPA (P < .05). Undergraduate science GPA, PSS-10 score (orientation administration), and age were included in the final version of the regression model as significant predictors of P1 year GPA.

CONCLUSIONS

Perceived stress increased over the P1 year, and higher perceived stress was associated with lower P1 academic performance. Future studies should examine strategies to assist P1s in managing stress.

Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients

INTRODUCTION

Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs).

OBJECTIVE

The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant.

METHODS

Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed.

RESULTS

A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07-0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03-0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses.

CONCLUSIONS

Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.

Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies

OBJECTIVES

Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone.

DESIGN

A cross-sectional survey conducted via telephone.

SETTING AND PARTICIPANTS

All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties).

OUTCOME MEASURES

Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted.

RESULTS

Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers.

CONCLUSION

Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access.

Factors Associated with Student Pharmacists' Academic Progression and Performance on the National Licensure Examination

Objective. To examine predictors of Doctor of Pharmacy (PharmD) students' on-time graduation, dismissal from pharmacy school, and scores on their first attempt at taking the North American Pharmacist Licensure Examination (NAPLEX). Methods. A retrospective review of student records for the graduating classes of 2015-2018 at a college of pharmacy was performed. Data on the following were collected: student demographics/characteristics (age, gender, race/ethnicity, financial need), having an undergraduate degree, undergraduate science grade point average (GPA), Pharmacy College Admission Test composite score percentile, pharmacy school GPAs for the didactic portion of the curriculum, Pre-NAPLEX score, on-time graduation from pharmacy school, dismissal from pharmacy school, and outcome (pass/fail) of first-attempt at taking the NAPLEX. Binary logistic regression analysis was conducted. Results. Of the 657 students whose records were included in the study, the majority were female (60%) and non-Hispanic white (70%). Higher first-year GPA was associated with increased likelihood of on-time graduation, while increased age and having an undergraduate degree were associated with a decreased likelihood of on-time graduation. A higher first-year GPA was associated with decreased likelihood of being dismissed from pharmacy school. Appearing before the Academic Standing and Promotion Review Committee for unsatisfactory academic performance was associated with decreased likelihood of passing the NAPLEX. Conclusion. First-year pharmacy school GPA is a critical predictor for student pharmacists in terms of on-time graduation and dismissal, and may have consequences for later NAPLEX outcome. Pharmacy schools should closely monitor students' performance during the first year and provide support to students experiencing academic difficulties.

Analysis of Educational Debt and Income Among Pharmacists and Other Health Professionals

Objective. To evaluate educational debt-to-income trends in pharmacy, dentistry, medicine, optometry, and veterinary medicine in the United States from 2010 to 2016. Methods. A retrospective analysis of educational debt and income for selected health professions was conducted. Data on student loan debt were collected from professional organizations and data on income were collected from the American Community Survey. Ratios of the mean educational debt of graduating students to the median annual income for their respective profession were calculated for 2010 through 2016. Average change per year in debt, income, and debt-to-income ratio were calculated. Results. Debt-to-income ratios for all selected health professions except medicine exceeded 100%. For physicians, debt-to-income ratios ranged from 89% to 95%. On average, physicians (-0.3 percentage point) and optometrists (-0.5 percentage point) had negative changes in their debt-to-income ratios from 2010 to 2016. Average increases per year in debt-to-income ratio of veterinarians, pharmacists, and dentists were 5.5, 5.7, and 6.0 percentage points, respectively. From 2010 to 2016, dentists had the largest average increase per year in debt ($10,525), while physicians had the largest average increase per year in income ($6667) and a minimal average debt increase per year ($5436). Pharmacists had the second largest average increase per year in debt ($8356). Conclusion. Educational debt-to-income ratios in the United States increased considerably over the past decade among pharmacists, dentists, and veterinarians and can negatively impact health professionals as well as patient care. Innovative strategies are needed to alleviate the educational debt burden.

Development of an Instrument to Measure Academic Resilience Among Pharmacy Students

Objective. To develop a valid and reliable academic resilience scale for use in the didactic portion of the Doctor of Pharmacy curriculum to identify those pharmacy students who have greater capacity to overcome academic adversity. Methods. A cross-sectional survey was conducted among first-year, second-year, and third-year pharmacy students to assess psychometric properties of a 30-item adapted academic resilience scale. Data were also collected using the Short Grit Scale (Grit-S). Demographic characteristics were collected from student records. Exploratory factor analysis was applied to determine the number of underlying factors responsible for data covariation. Principal components analysis was used as the extraction method. Varimax rotation method was used, and the Cronbach alpha was estimated. Validity testing was conducted by calculating Pearson's r correlations between the adapted academic resilience scale and Grit-S. Results. The survey response rate was 84%. The final version of the scale, the Academic Pharmacy Resilience Scale (APRS-16), had four subscales and 16 items (14 items failed to load on any of the factors and were deleted). The Cronbach alpha was .84, indicating strong internal consistency. The APRS-16 and its subscales were significantly correlated to the Grit-S and its subscales, providing evidence of effective convergent validity. Conclusion. Evidence supports the reliability and validity of the APRS-16 as a measure of academic resilience in pharmacy students. Future studies should use the APRS-16 to investigate the relationship between academic resilience and performance outcomes among pharmacy students.

Effects of the 2013 American College of Cardiology/American Heart Association guidelines on racial and ethnic disparities in statin treatment among diabetics

BACKGROUND

Significant racial and ethnic disparities in statin prescribing and utilization have been constantly documented.

OBJECTIVE

To examine whether racial/ethnic disparities in statin treatment have decreased among the diabetic population after the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines.

METHODS

This retrospective study analyzed patients with diabetes aged 40-75 years old in the Medicare Expenditure Panel Survey (2011-2012 and 2014-2015). Racial and ethnic disparities in the likelihood of statin use and number of statin prescriptions were compared before and after the guideline release. Logistic and negative binomial regressions were used to adjust for patient characteristics. A difference-in-difference model (DID) was used to examine disparity changes.

RESULTS

This study included 2584 patients from 2011 to 2012 and 2610 from 2014 to 2015. During 2011-2012, racial/ethnic disparities were significant for the likelihood of statin use. For the number of statin prescriptions, racial disparity was significant, but not for the ethnic disparity. During 2014-2015, racial/ethnic disparities were significant for the likelihood of statin use but were not significant for the number of statin prescriptions. The DID model found that the 2013 guidelines were not associated with a reduction in racial and ethnic disparities in statin treatment.

CONCLUSIONS

This study found persistent disparities in the likelihood of statin use. The 2013 ACC/AHA guidelines were not associated with a reduction in racial and ethnic disparities in statin treatment.

Examination of Factors Relating to Student Performance on the Pharmacy Curriculum Outcomes Assessment

Objective. To examine relationships between students' demographic and academic performance factors and their scores on the Pharmacy Curriculum Outcomes Assessment (PCOA). Methods. Students' PCOA scores and demographics (eg, age, race/ethnicity, sex), preadmission data [eg, cumulative and science grade point average (GPA), Pharmacy College Admissions Test (PCAT)], and academic performance variables (eg, pharmacy GPA, academic standing) were analyzed for one class of third-year pharmacy students (N=159). Independent t-tests and Analysis of Variance (ANOVA) were used to compare scores by demographic variables. Pearson's r correlations were used to assess relationships between PCOA scores and age, PCAT scores, and GPA. Stepwise linear regression was conducted to determine the predictive ability of variables with significant correlations to PCOA performance. Results. Significant correlations were found between sex and PCOA scores with males scoring higher than females. Significant correlations with PCOA scores were also found for PCAT scores, pre-pharmacy science GPA, and pharmacy didactic GPA. Significant differences were found by academic standing, where students in academic difficulty who were allowed to proceed without repeating curricular content scored significantly lower on the PCOA than those who did not experience academic difficulty. Conversely, there were no statistical differences between those who repeated courses and those who never experienced academic difficulty. PCOA performance predictors in the final regression model included PCAT composite score, pharmacy GPA and sex. Conclusion. New findings included differences in PCOA scores by sex and by academic standing, a variable not previously explored in published studies. Findings have implications for remediation decisions in pharmacy curricula.

Comparative Effectiveness of Medication Therapy Management Eligibility Criteria Across Racial/Ethnic Groups

BACKGROUND/OBJECTIVES

Previous research indicates that eligibility criteria for medication therapy management (MTM) services in Medicare prescription drug (Part D) plans, defined under the Medicare Modernization Act (MMA), are associated with racial/ethnic disparities and ineffective in identifying individuals with medication utilization issues. Our study's objective was to determine the comparative effectiveness of MTM eligibility criteria under MMA and in the Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial/ethnic groups.

DESIGN

ACA and MMA MTM eligibility criteria were compared on proportions of eligible individuals among patients with medication utilization issues. Multinomial logistic regression was conducted to control for patient/community characteristics. Need-based and demand-based analyses were used to determine disparities due to need and demand for healthcare. Main/sensitivity analyses were conducted for the range of eligibility thresholds.

SETTING

Medicare data (2012-2013) linked to Area Health Resources Files.

PARTICIPANTS

A total of 964 610 patients 65 years or older.

MEASUREMENTS

Medication safety/adherence measures, developed primarily by the Pharmacy Quality Alliance, were used to determine medication utilization issues.

RESULTS

Higher proportions of patients were eligible based on ACA than MMA MTM eligibility criteria. For example, in 2013, proportions based on ACA and MMA MTM eligibility criteria would be 99.7% and 26.2%, respectively, in the main analysis (p < .001); in the demand-based main analysis, ACA criteria were associated with 13.6% and 9.8%, respectively, higher effectiveness than MMA criteria among non-Hispanic blacks and Hispanics than non-Hispanic whites.

CONCLUSION

ACA MTM eligibility criteria are more effective than MMA criteria in identifying older patients needing MTM, particularly among minorities. J Am Geriatr Soc 67:581-587, 2019.

Health literacy in solid-organ transplantation: a model to improve understanding

Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy. Based on the Paasche-Orlow and Wolf model of health literacy, the Health Literacy Model in Transplantation (HeaL-T) provides a foundation to visually demonstrate the relationships among variables associated with low health literacy and to develop evidence-based strategies to improve care. The model depicts a number of patient and healthcare level factors associated with health literacy, several of which have bi-directional or reciprocal relationships, including access and utilization of healthcare, provider-patient interaction, and self-management/adherence. The impact of these factors and their relationships to SOTR outcomes are reviewed. The HeaL-T represents an important step in developing holistic understanding of the complexity of health literacy in SOTRs and offers clinicians a base from which to design strategies to mitigate adverse health effects including increased hospitalizations, graft failure, and mortality.

Higher Predictive Value Positive for MMA Than ACA MTM Eligibility Criteria Among Racial and Ethnic Minorities: An Observational Study

The objective of this study was to examine positive predictive value (PPV) of medication therapy management (MTM) eligibility criteria under Medicare Modernization Act (MMA) and Affordable Care Act (ACA) in identifying patients with medication utilization issues across racial and ethnic groups. The study analyzed Medicare data (2012-2013) for 2 213 594 beneficiaries. Medication utilization issues were determined based on medication utilization measures mostly developed by Pharmacy Quality Alliance. MMA was associated with higher PPV than ACA in identifying individuals with medication utilization issues among non-Hispanic blacks (blacks) and Hispanics than non-Hispanic whites (whites). For example, odds ratio for having medication utilization issues to whites when examining MMA in 2013 and ACA were 1.09 (95% confidence interval [CI] = 1.04-1.15) among blacks, and 1.17 (95% CI = 1.10-1.24) among Hispanics, in the main analysis. Therefore, MMA was associated with 9% and 17% higher PPV than ACA in identifying patients with medication utilization issues among blacks and Hispanics, respectively, than whites.

Meeting report: FDA public meeting on patient-focused drug development and medication adherence in solid organ transplant patients

The Food and Drug Administration (FDA) held a public meeting and scientific workshop in September 2016 to obtain perspectives from solid organ transplant recipients, family caregivers, and other patient representatives. The morning sessions focused on the impact of organ transplantation on patients' daily lives and the spectrum of activities undertaken to maintain grafts. Participants described the physical, emotional, and social impacts of their transplant on daily life. They also discussed their posttransplant treatment regimens, including the most burdensome side effects and their hopes for future treatment. The afternoon scientific session consisted of presentations on prevalence and risk factors for medication nonadherence after transplantation in adults and children, and interventions to manage it. As new modalities of Immunosuppressive Drug Therapy are being developed, the patient perceptions and input must play larger roles if organ transplantation is to be truly successful.

Associations Between Pharmacy Students' Attitudes Toward Debt, Stress, and Student Loans

Objective. To assess graduating pharmacy students' attitudes toward debt and determine associations with stress, student loan debt, financial need, current employment, post-graduation plans, and expected length of time to repay loans. Methods. Survey was conducted using an attitudes-toward-debt scale (sub-scales: tolerant attitudes toward debt; contemplation and knowledge about loans; fear of debt), Perceived Stress Scale, and questions concerning current employment, estimated total student loan debt, post-graduation plans, and expected length of time to repay loans. Federal loan data were collected using financial aid records. Independent samples t-test, ANOVA, and Pearson's r correlations were conducted. Results. There were 147 students (96.7%) who participated. The majority were female (59.2%), white (69.4%), and had federal student loans (90.5%). Mean total loan amount was $153,276 (SD $59,810), which included federal students loans accumulated before and during pharmacy school. No significant differences were noted on attitudes toward debt or stress based on whether respondents had federal student loans. Greater "fear of debt" was correlated with increased stress, estimated total student loan debt, total federal loan debt, and pharmacy school loan debt. Greater "contemplation and knowledge about loans" was correlated with lower estimated total student loan debt, total federal loan amount, and pharmacy school loan amount. Students with higher "contemplation and knowledge" scores expected to repay loans within a shorter time frame than students with lower scores. Conclusion. Increased fear of debt was related to greater perceived stress and higher student loan amounts borrowed, while increased contemplation and knowledge about loans was associated with lower amounts borrowed. Educational programming concerning loans, debt, and personal financial management may help reduce stress and amount borrowed.

Examining the Association Between the NAPLEX, Pre-NAPLEX, and Pre- and Post-admission Factors

Objective. To examine the relationship between the NAPLEX and Pre-NAPLEX among pharmacy graduates, as well as determine effects of pre-pharmacy, pharmacy school, and demographic variables on NAPLEX performance. Methods. A retrospective review of pharmacy graduates' NAPLEX scores, Pre-NAPLEX scores, demographics, pre-pharmacy academic performance factors, and pharmacy school academic performance factors was performed. Bivariate (eg, ANOVA, independent samples t-test) and correlational analyses were conducted, as was stepwise linear regression to examine the significance of Pre-NAPLEX score and other factors as related to NAPLEX score. Results. One hundred fifty graduates were included, with the majority being female (60.7%) and white (72%). Mean NAPLEX score was 104.7. Mean Pre-NAPLEX score was 68.6. White students had significantly higher NAPLEX scores compared to Black/African American students. NAPLEX score was correlated to Pre-NAPLEX score, race/ethnicity, PCAT composite and section scores, undergraduate overall and science GPAs, pharmacy GPA, and on-time graduation. The regression model included pharmacy GPA and Pre-NAPLEX score. Conclusion. The findings provide evidence that, although pharmacy GPA is the most critical determinant, the Pre-NAPLEX score is also a significant predictor of NAPLEX score.

Development of an Instrument to Measure Pharmacy Student Attitudes Toward Social Media Professionalism

Objectives. To develop and validate a scale measuring pharmacy students' attitudes toward social media professionalism, and assess the impact of an educational presentation on social media professionalism. Methods. A social media professionalism scale was used in a pre- and post-survey to determine the effects of a social media professionalism presentation. The 26-item scale was administered to 197 first-year pharmacy (P1) students during orientation. Exploratory factor analysis was applied to determine the number of underlying factors responsible for covariation of the data. Principal components analysis was used as the extraction method. Varimax was selected as the rotation method. Cronbach's alpha was estimated. Wilcoxon signed rank test was used to compare pre- and post-scores of each item, subscale, and total scale. Results. There were 187 (95%) students who participated. The final scale had five subscales and 15 items. Subscales were named according to the professionalism tenet they best represented. Scores of items addressing reading/posting to social media during class, an employer's use of social media when making hiring decisions, and a college/university's use of social media as a measure of professional conduct significantly increased from pre-test to post-test. The "honesty and integrity" subscale score also significantly increased. Conclusion. The social media professionalism scale measures five tenets of professionalism and exhibits satisfactory reliability. The presentation improved P1 students' attitudes regarding social media professionalism.

Net Income of Pharmacy Faculty Compared to Community and Hospital Pharmacists

Objective. To compare the net cumulative income of community pharmacists, hospital pharmacists, and full-time pharmacy faculty members (residency-trained or with a PhD after obtaining a PharmD) in pharmacy practice, medicinal chemistry, pharmaceutics, pharmacology, and social and administrative sciences. Methods. Markov modeling was conducted to calculate net projected cumulative earnings of career paths by estimating the costs of education, including the costs of obtaining degrees and student loans. Results. The economic model spanned 49 years, from ages 18 to 67 years. Earning a PharmD and pursuing an academic career resulted in projected net cumulative lifetime earnings ranging from approximately $4.7 million to $6.3 million. A pharmacy practice faculty position following public pharmacy school and one year of residency resulted in higher net cumulative income than community pharmacy. Faculty members with postgraduate year 1 (PGY1) training also had higher net income than other faculty and hospital pharmacy career paths, given similar years of prepharmacy education and type of pharmacy school attended. Faculty members with either a PharmD or PhD in the pharmacology discipline may net as much as $5.9 million and outpace all other PhD graduates by at least $75 000 in lifetime earnings. Projected career earnings of postgraduate year 2 (PGY2) trained faculty and PharmD/PhD faculty members were lower than those of community pharmacists. Findings were more variable when comparing pharmacy faculty members and hospital pharmacists. Conclusion. With the exception of PGY1 trained academic pharmacists, faculty projected net cumulative incomes generally lagged behind community pharmacists, likely because of delayed entry into the job market as a result of advanced training/education. However, nonsalary benefits such as greater flexibility and autonomy may enhance the desirability of academic pharmacy as a career path.

Medication therapy management and adherence among US renal transplant recipients

BACKGROUND

Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients' (RTRs) immunosuppressant therapy (IST) adherence. This study's purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant.

METHODS

Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression.

RESULTS

In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02-1.26, P=0.02).

CONCLUSION

The findings provide evidence that access to MTM services increases IST adherence among RTRs.

Break-Even Income Analysis of Pharmacy Graduates Compared to High School and College Graduates

Objective. To project the net cumulative income break-even point between practicing pharmacists and those who enter the workforce directly after high school graduation or after obtaining a bachelor's degree. Methods. Markov modeling and break-even analysis were conducted. Estimated costs of education were used in calculating net early career earnings of high school graduates, bachelor's degree holders, pharmacists without residency training, and pharmacists with residency training. Results. Models indicate that over the first 10 years of a pharmacist's career, they accumulate net earnings of $716 345 to $1 064 840, depending on cost of obtaining the PharmD degree and career path followed. In the break-even analysis, all pharmacy career tracks surpassed net cumulative earnings of high school graduates by age 33 and bachelor's degree holders by age 34. Conclusion. Regardless of the chosen pharmacy career track and the typical cost of obtaining a PharmD degree, the model under study assumptions demonstrates that pharmacy education has a positive financial return on investment, with a projected break-even point of less than 10 years upon career entry.

Student Pharmacists' Perceptions of a Composite Examination in Their First Professional Year

OBJECTIVE

To assess first-year (P1) pharmacy students' studying behaviors and perceptions after implementation of a new computerized "composite examination" (CE) testing procedure.

METHODS

Student surveys were conducted to assess studying behavior and perceptions about the CE before and after its implementation.

RESULTS

Surveys were completed by 149 P1 students (92% response rate). Significant changes between survey results before and after the CE included an increase in students' concerns about the limited number of questions per course on each examination and decreased concerns about the time allotted and the inability to write on the CEs. Significant changes in study habits included a decrease in cramming (studying shortly before the test) and an increase in priority studying (spending more time on one course than another).

CONCLUSION

The CE positively changed assessment practice at the college. It helped overcome logistic challenges in computerized testing and drove positive changes in study habits.

Economic Analysis of Obtaining a PharmD Degree and Career as a Pharmacist

Objective. To evaluate the economic value of pharmacy education/career and the effects of the cost of private or public pharmacy school, the length of degree program, residency training, and pharmacy career path on net career earnings. Methods. This study involved an economic analysis using Markov modeling. Estimated costs of education including student loans were considered in calculating net career earnings of 4 career paths following high school graduation: (1) immediate employment; (2) employment with bachelor's degree in chemistry or biology; (3) employment as a pharmacist with no residency training; and (4) employment as a pharmacist after completing one or two years of residency training. Results. Models indicated that throughout their careers (up to age 67), PharmD graduates may accumulate net career earnings of $5.66 million to $6.29 million, roughly 3.15 times more than high school graduates and 1.57 to 1.73 times more than those with bachelor's degrees in biology or chemistry. Attending a public pharmacy school after completing 3 years of prepharmacy education generally leads to higher net career earnings. Community pharmacists have the highest net career earnings, and PGY-1 residency-trained hospital pharmacists have greater net career earnings than those who immediately started their careers in a hospital setting. Conclusion. The economic models presented are based on assumptions described herein; as conditions are subject to variability, these models should not be used to predict future earnings. Nevertheless, the findings demonstrate investment in a pharmacy education yields favorable financial return. Application of results to schools of pharmacy, students, and graduates is discussed.

Factors Associated with Student Pharmacist Philanthropy to the College Before and After Graduation

Objective. To examine the early stages of a student giving program, to evaluate the program's influence on college donations, and to evaluate other factors that may affect student and year-one postgraduation giving at a college or school of pharmacy. Methods. A review of student records for graduates of 2013 and 2014 was conducted. Data included student characteristics, scholarship support, international program participation, senior class gift participation, and postgraduation giving. Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, and Chi-square analyses were performed. Results. Of 273 graduates, the majority were female (57.1%) and white (74%). Class of 2014 contributed a higher amount to the class gift than the prior class. In 2014, those who received scholarships gave higher amounts to the class gift. For the combined classes, there was an association between the number of students who gave pregraduation and the number who gave postgraduation. In the 2013 class, individuals gave greater amounts postgraduation compared to pregraduation, and a higher percentage of alumni (8%) gave postgraduation compared to alumni from the previous class (<1%). Conclusion. Participation in year-one postgraduation giving increased after implementation of the senior class gift program. Receiving scholarships influenced giving to the class gift but was not associated with postgraduation giving. Future studies are needed to develop a more comprehensive understanding of student and alumni philanthropy.