Leadership of the Consortium for Health Policy, Law and Bioethics

poster abstractThe Consortium for Health Policy, Law, and Bioethics completed another successful year of educational programs, public outreach, and collaborative research. Educational highlights include (1) offering for the second time, an innovative graduate course co-taught by the three Consortium-directors (Wright, Kinney, Meslin) that is open to students in law, public health, philosophy; (2) The addition of a new “concentration in international research ethics” (offered in the Philosophy Department that is now eligible for joint-degree status with the JD; and (3) approval of a new JD/MSW. Research highlights include (1) twenty publications (2) several grants awarded to Consortium co-directors; $4,958,909.75 and (3) the establishment of year-long a multidisciplinary study group focusing on ethical, legal, social, and policy issues involving comparative effectiveness research. Outreach highlights include nine presentations to community groups, professional associations, and academic institutions

Promoting consistent use of prescription drug monitoring programs (PDMP) in outpatient pharmacies: Removing administrative barriers and increasing awareness of Rx drug abuse

Background Prescription drug monitoring programs (PDMPs) are proving to be valuable resources in fighting the prescription drug abuse epidemic through improved access to patient drug histories. Ninety-four percent of Indiana pharmacists have heard of Indiana's PDMP (INSPECT), only 71% of them reported using the program in 2012. Objective To identify barriers to PDMP use in outpatient pharmacies and determine the impact these barriers have on utilization. Methods A cross-sectional study examined pharmacists' knowledge and use of INSPECT. Bivariate analyses on utilization and perceived barriers were conducted using cross-tabulations and chi-squared tests. Multiple logistic regression examined the relationship between pharmacists' level of concern with prescription drug abuse and reported utilization. Results Pharmacists were significantly less likely to use INSPECT if they reported at least one barrier and 3 times more likely to use INSPECT if they reported no barrier. Pharmacists were 10 times more likely to use INSPECT and 18 times more likely to use it more consistently if they were extremely concerned about prescription drug abuse in their community as compared to those not at all concerned. Conclusion Strategies to improve utilization of PDMPs should look for innovative ways to limit barriers and build outpatient pharmacists' awareness of prescription drug abuse and misuse within their community

Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist's professional judgment

Background Pharmacists have shared responsibility to investigate the validity of controlled substance prescriptions (CSPs) that raise concerns, or red flags, and subsequently exercise their right to refuse to dispense a CSP if its validity cannot be verified. Improving access to clinical practice tools, such as prescription drug monitoring programs (PDMPs), may increase availability of a patient's drug history, which is critical to making informed clinical decisions about dispensing CSPs. Objectives The purpose of this study was to examine how integration and consistent use of a PDMP in pharmacy practice impacts pharmacists' dispensing practices related to CSPs. Methods A cross-sectional study examined pharmacists' knowledge and use of Indiana's (US State) PDMP (INSPECT) and dispensing practices of CSPs. Three outcome measures were analyzed using multiple logistic regression so as to examine the relationship between PDMP use and pharmacists' controlled substance dispensing behaviors. Results Pharmacists were 6.4 times more likely to change their dispensing practice to dispense fewer CSPs if they reported that INSPECT provides increased access to patient information. Pharmacists who always use INSPECT refused an average of 25 CSPs annually compared to an average of 7 refusals for pharmacists not using INSPECT. Pharmacists using INSEPCT consistently (at every visit) were 3.3 times more likely to refuse to dispense more CSPs than pharmacists who report never using INSPECT. Conclusions Integration of PDMPs in pharmacy practice may improve a pharmacist's ability to make informed clinical decisions and exercise sound professional judgment. Providing clinical practice tools to both prescribers and pharmacists is important to preventing drug diversion and prescription drug abuse. Future research should focus on understanding the barriers and challenges to successful integration of PDMPs in pharmacy practice

Key Findings and Recommendations from the 2013 IPLA INSPECT Knowledge and Use Survey

The Center for Health Policy in collaboration with the Indiana Professional Licensing Agency and the State Prescription Drug Abuse Prevention Task Force’s Education Committee developed a web-based survey to gather information on prescribers’ and dispensers’ knowledge, use, and opinions of INSPECT as well as to assess prescribers’ and dispensers’ attitudes and beliefs about prescribing and dispensing opioids. Key findings suggest that both providers and dispensers are strongly supportive and frequent users of the INSPECT program; the majority of users believe INSPECT is generally effective and a valuable tool in state-wide efforts to reduce the misuse, abuse, and diversion of prescription drugs.Indiana Professional Licensing Agency: INSPECT Evaluation Grant #A262-3-250-10

Institutional Capacity to Respond to the Ethical Challenges of Patient Sexual Expression in State Psychiatric Hospitals in the United States

Patient sexual expression in psychiatric institutions is a major clinical and administrative challenge. For this study, hospital facility directors were surveyed and asked about the existence and nature of formal policies regarding patient sexuality-related needs and staff preparedness to handle various forms of patient sexual expression. Consistent with prior studies, the survey fi ndings show formal policies tend to enforce a punitive response to sexual behavior. More important, the results also reveal a workforce poorly prepared to negotiate the complex ethical issues that arise in addressing patient sexual expression in state psychiatric institutions in the U.S

ATTITUDES AND PERCEPTIONS OF LIVING KIDNEY DONOR EVALUATION

poster abstractIntroduction: Attitudes and perceptions of living kidney donors are im-portant aspects to the organ donation process. Few patient-centered studies exist which focus on broad health outcomes and expectations of living kid-ney donors. This is of practical concern due to the trend of decreasing donor numbers observed in the last decade (U.S. Department of Health and Human Services, Health Resources and Services Administration, 2011). While fol-low-up care is a crucial part of the donation process, few studies address the importance of follow-up care and its implications on the health status of the donor following his/her donation. This study aims to evaluate attitudes and perceptions of living kidney donors regarding their total donation experience. Data collected will shape policy recommendations pertaining to the standard of follow-up care for living kidney donors. Methods: The present study uses an electronic survey tool to evaluate living kidney donors’ satisfaction with their post-donation follow-up care. All living kidney donors are eligible. Recruitment is via social networking sites with active donor members; successfully recruited participants receive an e-mail with the study information sheet and a link to the brief survey. Results: Completed survey responses are coded and analyzed using sta-tistical coding software. Data produced will illustrate any patient reported negative health outcomes across multiple transplant centers, attitudes about donor follow-up care, and policy recommendations

Improving Transit Predictions of Known Exoplanets with TERMS

Transiting planet discoveries have largely been restricted to the short-period or low-periastron distance regimes due to the bias inherent in the geometric transit probability. Through the refinement of planetary orbital parameters, and hence reducing the size of transit windows, long-period planets become feasible targets for photometric follow-up. Here we describe the TERMS project that is monitoring these host stars at predicted transit times.Comment: 3 pages, 2 figures, to be published in ASP Conf. Proceedings: "Detection and dynamics of transiting exoplanets" 2010, OHP, France (eds.: F. Bouchy, R.F. D{\i}az, C. Moutou

Psychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services

Objectives We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. Methods Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees’ (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. Results A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. Conclusions This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos’ orientation toward dental care

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity

OBJECTIVE: Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. METHOD: A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. RESULTS: Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning