Patterns of Treatment for Psychiatric Disorders Among Children and Adolesecents in Mississippi Medicaid

The nature of services for psychiatric disorders in public health systems has been understudied, particularly with regard to frequency, duration, and costs. The current study examines patterns of service reception and costs among Medicaid-covered youth newly diagnosed with anxiety, depression, or behavioral disturbance in a large data set of provider billing claims submitted between 2015–2016. Eligibility criteria included: 1) identification of an initial diagnosis of a single anxiety, unipolar mood, or specific behavioral disorder; 2) continuous Medicaid eligibility over the duration of the time period studied; and 3) under 18 years of age on the date of initial psychiatric diagnosis. The final cohort included 7,627 cases with a mean age of 10.65 (±4.36), of which 58.04% were male, 57.09% were Black, 38.97% were White, and 3.95% were of other ethnicities. Data indicated that 65.94% of the cohort received at least some follow-up services within a median 18 days of diagnosis. Of those, 54.27% received a combination of medical and psychosocial services, 32.01% received medical services only, and 13.72% received psychosocial services only. Overall median costs for direct treatment were $576.69, with wide discrepancies between the lowest (anxiety =$308.41) and highest (behavioral disturbance = $653.59) diagnostic categories. Across all categories the frequency and duration of psychosocial services were much lower than would be expected in comparison to data from a well-known effectiveness trial. Overall, follow-up to psychiatric diagnosis could be characterized as highly variable, underutilized, and emphasizing biomedical treatment. Understanding more about these patterns may facilitate systematic improvements and greater cost efficiency in the future

The Changing Retail Environment: Its Influence On Professionalism In Chain And Independently Owned Pharmacies

The purpose of this study was to determine if pharmacists could be differentiated with respect to practice site based on their responses to several questions related to professionalism and its consequential influence on pharmacy image. Results revealed that several qualities associated with professionalism (e.g., skills, knowledge, ethics, service, and environment) could be used to distinguish pharmacists by practice site. In general, pharmacists whose primary practice sites were a chain store pharmacy evaluated the items relating to professionalism, work environment, and image more negatively than pharmacists whose primary practice sites were an independently owned pharmacy. Implications for the retail marketing environment, pharmacy management, and pharmacy image are also discussed

The Effects of Acquisition Cost and Budget-Based Compensation on the Attitudes of Pharmacy Directors toward the Adoption of a Cost-Effective Drug

To test the effect of differences in acquisition cost and budget-based monetary compensation systems on the intent to support the adoption of a cost-effective new drug, over 350 hospital pharmacy directors were asked to indicate their intentions as to the adoption of a cost-effective new thrombolytic agent, presented at 3 different prices. Although the economic savings for the hypothetical product were constant across all price points tested, respondents exposed to the highest price were more likely to resist the adoption of the new agent than those exposed to lower prices (p \u3c 0.001). Respondents whose compensation was contingent on their control of the drug budget indicated a higher likelihood to resist the adoption of the new agent than did those whose salary was not so determined. These findings indicate that significant hurdles, psychological and organizational, still exist for the acceptance and use of pharmacoeconomic information in the hospital setting

The role of perceived impact on relationship quality in pharmacists\u27 willingness to influence indication-based off-label prescribing decisions

Little is known about factors that affect pharmacists\u27 roles in off-label prescribing. This study examined the effect of perceived impact on relationship quality (IRQ) on hospital pharmacists\u27 willingness to influence a physician\u27s decision regarding an indication-based off-label medication order (WTIP) (i.e., beyond FDA-approved indications) and the moderating roles of the appropriateness of the medication order and the relative expert power of the pharmacist. Pharmacists practicing in U.S. hospitals, recruited from membership rolls of state affiliates of the American Society of Health-System Pharmacists, were sent an electronic link to a questionnaire via their respective affiliates. A cross-sectional, randomized, 2 × 2 experimental design was used; participants were assigned to one of the indication-based off-label medication order scenarios. Relative expert power (i.e., power differential between the pharmacist and the physician) and appropriateness of the prescription were manipulated. Perceived IRQ was measured with multiple items. Pharmacists\u27 WTIP in the scenario was the outcome variable. A total of 243 responses were included in multiple linear regression analyses. After controlling for dependence power, information power, communication effectiveness, perceived responsibility, and attitude, pharmacists\u27 WTIP was negatively affected by perceived IRQ (estimate = −0.309, P \u3c 0.05). This effect was more pronounced in groups exposed to the scenario where the pharmacist had lower relative expert power (estimate = −0.438, P \u3c 0.05) and where the medication was less appropriate (estimate = −0.503, P \u3c 0.05). Although willing to ensure rationality of off-label prescribing, pharmacists\u27 WTIP was affected by a complex array of factors – the perceived impact of influence attempts on relationship quality between the pharmacist and the prescriber, the pharmacist\u27s relative expert power, and the appropriateness of the off-label prescription. Increasing pharmacists\u27 expert power and collaboration with physicians and promoting pharmacists\u27 multifaceted contribution, collaborative or independent, to patient care may facilitate pharmacist services in off-label pharmaceutical care

The Effects of Acquisition Cost and Budget-Based Compensation on the Attitudes of Pharmacy Directors Toward the Adoption of a Cost-Effective New Drug

To test the effect of differences in acquisition cost and budget-based monetary compensation systems on the intent to support the adoption of a cost-effective new drug, over 350 hospital pharmacy directors were asked to indicate their intentions as to the adoption of a cost-effective new thrombolytic agent, presented at 3 different prices. Although the economic savings for the hypothetical product were constant across all price points tested, respondents exposed to the highest price were more likely to resist the adoption of the new agent than those exposed to lower prices (pPharmacoeconomics, Health-economics, Cost-containment, Cost-analysis

Development of the medication adherence estimation and differentiation scale (MEDS)

Objectives: To develop a self-reported measure for medication adherence and compare its ability to predict the proportion of days covered (PDC) with contemporary scales. Methods: Retrospective prescription fill data from three community pharmacies in the Southeastern US were assessed to identify patients that were 18 years of age or older, and had received at least one medication for diabetes, hypertension, or dyslipidemia. A cross-sectional survey containing the Medication adherence Estimation and Differentiation Scale (MEDS) was administered among these pharmacy patrons. The MEDS assessed the extent and reasons for non-adherence. Survey responses were anonymously linked with retrospective prescription fill data. A total of 685 patients were sampled. The proportion of days covered (PDC) was used as the criterion measure. The Morisky, Green, and Levine Adherence Scale (1986 Morisky scale) and the Medication Adherence Reasons Scale (MAR-Scale) were used as comparators. Results: The MEDS presented a five-factor solution—worries about side-effects, worries about addiction, worries about cost, lack of perceived need, and unintentional non-adherence (CFI = 0.97; RMSEA = 0.06; SRMR = 0.03; standardized factor loadings greater than 0.5, and statistically significant). The relationship between MEDS scores and PDC was statistically significant (unstandardized regression coefficient = –0.50, p \u3c .01). The MEDS performed better than the 1986 Morisky scale (R2 = 0.02 vs 0.05, standardized regression coefficient = –0.13 vs –0.21) and the MAR-Scale (R2 = 0.02 vs 0.05, standardized regression coefficient = –0.12 vs –0.21) in predicting PDC. Conclusions: The MEDS demonstrated good psychometric properties and performed better than the comparator scales in the prediction of PDC