Identification of the service quality dimensions of pharmaceutical education

Objectives. Describe the perceptual dimensions of student assessments of the quality of their education. Link those dimensions with student satisfaction with their educational experience. Methods. A 37-item educational service quality instrument and a seven-item satisfaction scale were administered to 372 students in their final year of education in years 1999 to 2002. Results. Factor analysis identified 5 dimensions of service quality labeled resources, interpersonal behavior of faculty, faculty expertise, faculty communication, and administration. Stepwise regression analysis showed that all factors were significantly related to overall satisfaction with each explaining the following percent variance: faculty interpersonal behavior (47%), administration (8%), resources (4%), faculty communication (3%), and faculty knowledge (1%). Mean scores of service quality dimensions demonstrated significant improvement from 1999 to 2002 for four of the five dimensions. Conclusion. The 5 dimensions of educational service quality found in this study are unique to the services marketing literature. Student perceptions of faculty are multidimensional with faculty interpersonal behavior explaining the most variance in student satisfaction responses

Understanding Off-Label Utilization Patterns of Two Biotechnology Drugs, Recombinant Erythropoietin Alfa and Darbepoetin Alfa: A Multi-Hospital Study

The American Medical Association (AMA) has estimated that as many as 40 percent of all prescriptions are issued for off-label use. Off-label prescribing is considered to be clinically beneficial and rational in certain life-threatening situations. However, off-label use can pose risks to patients in terms of adverse drug events as well as contribute to rising pharmaceutical costs. The anti-anemic drugs erythropoietin and darbepoetin are costly, and there are significant off-label uses for these drugs some of which are not supported with clinical evidence, hence were selected as study drugs. Our study goals included quantification of the prevalence rate and appropriateness of off-label use of erythropoietin and darbepoetin across U.S. hospitals, and identification of possible predictors of off-label use from the domains of patient characteristics, physician specialty, hospital characteristics and drug characteristics. To address the research questions we performed a retrospective review of 464,834 discharged patients across 515 hospitals who have received erythropoietin and darbepoetin from the time periods between 2001and 2004. The data was supplied by Solucient®. The uses of the two drugs have been categorized using an evidence-based medicine framework that classifies them into: a) on-label use (approved by the FDA), b) off-label use supported (use not approved by FDA but there is strong clinical evidence supporting off-label use), and c) off-label use unsupported (lack of clinical evidence). A multinomial logistic regression model clustered by hospitals was conducted to determine predictors of off-label use. The results of this study revealed that more than half of the utilization of the two erythropoietic drugs is for off-label purposes, the majority of which is supported with evidence. Among the covariates, physician specialty, patient age group, race, drug coverage and length of hospital stay were significant (0.05 level) predictors of off-label use (supported and unsupported) relative to on-label. It is useful to understand the extent and appropriateness of off-label utilization in order to ensure safe and cost-effective use in patients. The availability of empirically derived knowledge on the national level could precipitate the promulgation of more meaningful post-marketing surveillance measures

Hospital mortality and length of stay associated with Enterobacterales positive blood cultures: a multicenter analysis

ABSTRACT Delayed time to antimicrobial susceptibility results can impact patients’ outcomes. Our study evaluated the impact of susceptibility turnaround time (TAT) and inadequate empiric antibacterial therapy (IET) in patients with bloodstream infections (BSI) caused by Enterobacterales (ENT) species on in-hospital mortality and length of stay (LOS). This retrospective, multicenter investigation which included 29,570 blood ENT-positive admissions across 161 US healthcare facilities evaluated the association between antimicrobial susceptibility testing (AST) TAT, carbapenem susceptibility, and empiric therapy on post-BSI in-hospital mortality and LOS following an ENT BSI event in adult patients. After adjusting for outcomes covariates, post-BSI in-hospital mortality was significantly higher for patients in the IET vs adequate empiric therapy (AET) group [odds ratio (OR): 1.61 (95% CI: 1.32, 1.98); P 63 h [OR:1.48 (95% CI: 1.16, 1.90); P = 0.0017]. Patients with carbapenem non-susceptible (carb-NS) ENT BSI had significantly higher LOS (16.6 days, 95% CI: 15.6, 17.8) compared to carbapenem susceptible (carb-S, 12.2 days, 95% CI: 11.8, 12.6), (P 65 h (P = 0.005 and P< 0.0001, respectively) compared to TAT ≤42 h (reference). Inadequate empiric therapy (IET), carb-NS, and delayed AST TAT are significantly associated with adverse hospital outcomes in ENT BSI. Workflows that accelerate AST TAT for ENT BSIs and facilitate timely and adequate therapy may reduce post-BSI in-hospital mortality rate and LOS.IMPORTANCEFor patients diagnosed with bloodstream infections (BSI) caused by Enterobacterales (ENT), delayed time to antimicrobial susceptibility (AST) results can significantly impact in-hospital mortality and hospital length of stay. However, this relationship between time elapsed from blood culture collection to AST results has only been assessed, to date, in a limited number of publications. Our study focuses on this important gap using retrospective data from 29,570 blood ENT-positive admissions across 161 healthcare facilities in the US as we believe that a thorough understanding of the dynamic between AST turnaround time, adequacy of empiric therapy, post-BSI event mortality, and hospital length of stay will help guide effective clinical management and optimize outcomes of patients with ENT infections