Are Hospital Pharmacies More Efficient if They Employ Nurses?

This paper assesses the efficiency of utilizing nurses in Washington State hospital pharmacies. We take the perspective of a pharmacy department manager and model an input oriented hospital pharmacy production process. Data envelopment analysis (DEA) is used to examine both scale efficiency and technical efficiency, and differences across hospital pharmacies that use and do not use nurse staffing are analyzed using cross-tabulations and nonparametric hypothesis tests. The results indicate that the use of nurse staffing does not significantly impact either scale or technical efficiency. Thus, permitting nurses to play a greater role in hospital pharmacies does not adversely affect efficiency. This paper has important policy implications for hospital administrators and pharmacists.

Unintended Migration Consequences of US Welfare Reform

Researchers have analyzed whether US welfare reform has induced interstate migration. Empirical results are inconclusive because methodologies are based on pre-reform thinking. This paper presents a post-reform migration model. We find that recipients move to avoid harsh sanction policies, seek lenient work requirements, and extend time limits. Unlike the first two behavioral responses, the latter is controversial. Critics will argue that such moves are illegal, and violators can be prosecuted because states share data. However, only active cases are being shared, meaning violators cannot be caught. Our model produces testable hypotheses which are consistent with (and reconcile) previous empirical results.Migration, Welfare reform

What Factors Influence a Welfare Recipient’s Spell Length and Recidivism?

The Personal Responsibility and Work Reconciliation (PRWORA) Act of 1997 marked a significant change in US welfare policy. Under the terms of this legislation, welfare recipients are limited to 24 consecutive months of monetary benefits, not to exceed 60 months over an individual’s lifetime. The primary intent of PRWORA is to force people off of welfare roles and into the work force. However, it may also have created a second effect; namely that wel-fare recipients treat the 60 months of welfare benefits as a stockpile of wealth. If so, recipients might strategically move on and off of the welfare roles in order to increase the length of time before one exhausts his or her total lifetime benefits. This leads to a high number of “welfare spells”, each relatively short in duration. We present an empirical analysis using data from three counties in Washington State to test whether (and how) an individual’s ability to maxim-ize welfare spells varies by their potential employment opportunities and their socio-economic characteristics. We find that socio-economic characteristics such as race and gender, family structure and educational attainment all significantly influence welfare spells. Additionally, welfare spells differed significantly by county, indicating that local labor market conditions specific to those counties are also important in decisions to “bank” welfare benefits

Are Hospitals Seasonally Inefficient? Evidence from Washington State Hospitals

Efficiency measurement has been one of the most extensively explored areas of health services research over the past two decades. Despite this attention, few studies have examined whether a provider's efficiency varies on a monthly, quarterly or other, sub-annual basis. This paper presents an empirical study that looks for evidence of seasonal inefficiency. Using a quarterly panel of general, acute-care hospitals from Washington State, we find that hospital efficiency does vary over time; however, the nature of this dynamic inefficiency depends on the type of efficiency being measured. Our results suggest that technical and cost efficiency vary by quarter. Allocative and scale efficiency also vary on a quarterly basis, but only if the data are jointly disaggregated by quarter and another, firm-specific factor such as size or operating status. Thus, future research, corporate decisions and government policies designed to improve the efficiency of hospital care need to account for seasonal trends in hospital efficiency

Do In-Kind Benefits Influence Pharmacists’ Labor Supply Decisions?

This paper explores whether in-kind benefits influence the labor supply decisions of pharmacists. Particular attention is paid to decisions to supply more than thirty hours of labor per week, when in-kind benefits are usually standard. A distinction is also made between pharmacists in managerial and/or ownership positions and those in traditional staff positions. Using survey data from registered pharmacists in North Dakota, we find that the labor supply determinants for owners/managers and employees are significantly different. We also find that while in-kind benefits do not appear to influence the typical staff pharmacist’s decision of how many hours to work each week, certain, but not all, types of these benefits do influence the decision of the representative owner/manager. Furthermore, the determinants of hours worked, in general, do not differ across the thirty hour per week threshold

Focusing your walking intervention’s message: For mature audiences only

Public policy makers seek to launch initiatives and preventive measures that reduce spiraling healthcare costs. One way they can do this is by encouraging their constituencies to engage in physical activity, such as walking. Although the health benefits of walking have been well documented, the factors that contribute to such behavior are not well understood. We analyzed the effect of factors that the literature has identified on walking behavior for “mature” adults, aged 40 to 65, and find that the “physical” infrastructure of a community, such as the presence of sidewalks, crosswalks, and signals for pedestrians, affects walking significantly. Our study suggests that policy makers would be well-advised to channel their efforts in building and improving the physical infrastructure that enable walking in their communities and to communicate the presence of these to their constituencies without explicitly recommending walking to them

Evaluation of the entrustable professional activities (EPAs) of the population health promoter domain by North Dakota pharmacists

Objective.  Entrustable Professional Activities (EPAs) are a list of professional tasks (with associated competency ratings) that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. This manuscript assesses the perceived frequency of performing EPAs in the population health promoter (PHP) domain among pharmacists practicing in North Dakota. Methods.  This survey assessed the self-reported EPA activities (inclusive of the PHP domain) of registered pharmacists living and practicing in North Dakota. There were 990 pharmacists surveyed, and 457 (46.1%) of pharmacists responded. Results. Within the PHP domain, pharmacists reported performing “Minimize adverse drug events and medication errors” most frequently (mean=3.4, SD=2.0), followed by “Ensure that patients have been immunized against vaccine-preventable diseases” (mean=2.3, SD 2.3), “Maximize the appropriate use of medications in a population” (mean=2.2, SD 2.3), and “Identify patients at risk for prevalent diseases in a population” (mean=1.3, SD=1.9). In these Core EPAs PHP domains, the clinical pharmacists reported the highest level, followed by pharmacy managers and staff pharmacists. Conclusion. Pharmacists in North Dakota reported that EPAs in the PHP domain are practiced regularly. Thus, EPAs in the PHP domain have potential as a means to assess outcomes in pharmacy education and practice.

Appraisal of the entrustable professional activities (EPAs) patient care provider domain by North Dakota pharmacists

Background: Entrustable Professional Activities (EPAs) are the latest addition to a list of professional competencies that pharmacy educational organizations support, and accreditation organizations require, for assessment by colleges and schools of pharmacy. Objective: The study’s objective is to assess the use of Core EPAs in the patient care domain (by practice setting, position, and preceptor status) in contemporary pharmacy practice. Methods: This survey assessed the EPA activities of pharmacists practicing in North Dakota. The pharmacists were asked “how many times in the past 30 days have you delivered the following services in your practice setting?” Response options were: 0, 1, 2, 3, 4, and 5 or more times. Results: Of 990 potential respondents, 457 pharmacists (46.1%) returned a survey, and 107 (10.8%) answered every survey item in the patient care domain. Respondents reported that the highest rated activity items “Collect information to identify a patient's medication-related problems and health-related needs,” and “Analyze information to determine the effects of medication therapy, identify medication-related problems, and prioritize health-related needs” were performed an average of 3.9 times per week (SD=1.8), and 3.8 times per week (SD=2.0), respectively. Both of these items, were reported for 70% of the respondents at 5 or more times per week. For these items, the highest reported practice setting was ‘other’ practice settings (e.g., long-term care, community health centers) followed by chains, hospitals, and independent pharmacies. By position, clinical pharmacists and preceptors reported the highest activity levels for most EPAs and supportive example tasks.  Conclusions: This study provides empirical evidence suggesting (but not proving) that EPAs have potential as a means to assess outcomes in pharmacy education and practice. Our study sets the stage for future work that further refines and assesses core EPA activities and supportive example tasks to measure the impact of how this process relates to outcomes of care