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Biomedical subjects

Jon C Schommer

Publications and source records attributed to Jon C Schommer.

At least 19 recordsLinked to original sources
PubMed2006

Addressing the issue of channeling bias in observational studies with propensity scores analysis.

Randomized Clinical Trials (RCTs) remain the gold standard for determining the utility of pharmaceuticals especially from a safety and efficacy standpoint. However, restrictive entry criteria and stringent protocols can be barriers to generalizing RCT findings to real world practices and outcomes. Observational studies overcome these limitations of RCTs since they are representative of real world populations and practices. Nonetheless, attributing causality remains a major limitation in observational studies, due to the non-random assignment of subjects to treatment. Non-random assignment can lead to imbalances in risk-factors between the groups being compared and thus bias the estimates of the treatment effect. Non-random assignment can be particularly problematic in observational studies comparing older versus newer pharmaceuticals from similar therapeutic classes due to the phenomenon of channeling. Channeling occurs when drug therapies with similar indications are preferentially prescribed to groups of patients with varying baseline prognoses. In this manuscript we discuss the phenomenon of channeling and the use of a statistical technique known an propensity scores analysis which potentially adjusts for the effects of channeling. During the course of this manuscript we discuss tests for determining the quality of the derived propensity score, various techniques for utilizing propensity scores, and also the potential limitations of this technique. With the increasing availability of high quality pharmaceutical and medical claims data for use in observational studies, increased attention must be given to analytic techniques that adjust optimally for non-random assignment and resulting channeling bias. For research studies using observational study designs, propensity score analysis offers a reasonable solution to address the limitation of non-random assignment, especially when RCTs are too costly, time-consuming or not ethically feasible.

Bias↗
PubMed2006

Provision of risk management and risk assessment information: the role of the pharmacist.

BACKGROUND: There exists a need to conceptualize and understand the roles that pharmacists serve to help convince others such as patients, prescribers, and payers to value their contributions and to plan for the roles they could serve in the future within the health care system. OBJECTIVE: The purpose of this study was to (1) describe and track differences in pharmacists' and patients' views about the pharmacist's and physician's role in medication risk management and risk assessment in 1995, 1998, 2001, and 2004, and (2) describe associations between selected demographic variables and reported opinions about the pharmacist's role using data from 2004. METHODS: Brushwood's Risk Management/Risk Assessment Framework was used as a conceptual guide for developing 2 risk management and 2 risk assessment scenarios. For each scenario, study participants were asked to select the level of responsibility shared by physicians and pharmacists in addressing the drug therapy problem. Data were collected in 1995, 1998, 2001, and 2004 using random samples of pharmacists and patients as study subjects. Descriptive statistics and logistic regression analysis were used for analyzing the data. RESULTS: The results showed that pharmacists view their role as providing risk management information to patients and may view this role as adding value to patient care above and beyond a level that can be provided by a physician alone. In 2004, pharmacists started to view the risk assessment scenarios as being more their responsibility as well. Patients, on the other hand, consistently viewed their physician as having primary responsibility for their health care in all of the scenarios we studied. CONCLUSIONS: Pharmacists view their role as one that adds unique value to a patient's health through their provision of medication risk management and some types of risk assessment. However, patients do not yet view the pharmacist as the primary provider of either medication risk management or risk assessment information.

Attitude of Health Personnel↗
PubMed2006

Market dynamics of community pharmacies in Minnesota.

BACKGROUND: From a pharmacist workforce perspective, an understanding of pharmacy location is important for monitoring access points for pharmacist services such as medication dispensing, medication counseling, medication therapy management, and disease management. OBJECTIVE: To understand access to community pharmacies, our goal was to describe changes in pharmacy mix (independent vs chain) between 1992 and 2002 for 87 counties in Minnesota. Study objectives were to describe the association of (1) change in population density, (2) metropolitan designation, change in (3) proportion of nonwhite population, (4) proportion of elderly population, and (5) household income with change in (a) number of community pharmacies overall, (b) number of chain pharmacies, (c) number of independent pharmacies, and (d) the independent-to-total community pharmacy ratio. METHODS: Records from the State of Minnesota Board of Pharmacy were used to examine changes in the community pharmacy mix from 1992 to 2002. Data on county level demographics in 1990 and 2000 were obtained from the US Census Bureau and Datanet. Chi-square analysis was used to test the relationships between the independent and dependent variables. RESULTS: As of 2002, every county in Minnesota had at least one pharmacy as was the case in 1992. The ratio of independent to chain pharmacies changed from approximately 2:1 in 1992 to approximately 1:1 in 2002. Chi-square results revealed that change in population density was significantly associated with change in the number of community pharmacies overall (P<0.001) and with change in chain pharmacies (P=0.03). The findings revealed an interesting u-shaped pattern for the association between population density and change in independent pharmacies. CONCLUSIONS: It appears that chain pharmacies follow changes in population density for making decisions about market entry and exit. The results suggest that some independent pharmacies might be closing due to chain competition in high population density growth areas. However, there was also evidence to suggest that population density decline may be an important determinant of independent pharmacy closures. In such environments, chain pharmacies are not likely to open new pharmacies to replace the independent pharmacy. Such a market dynamic may lead to access problems for citizens of these counties in the future.

Health Care Sector↗
PubMed2006

Examining gender salary disparities: an analysis of the 2003 multistate salary survey.

BACKGROUND: Pharmacist salary and wage surveys have been conducted at the state and national level for more than 20 years; however, it is not known to what extent, if any, wage disparities due to gender still exist. OBJECTIVES: The overall objective of this study was to determine if wage disparities exist among male and female pharmacists at the multistate and individual state level for each of 6 states studied. A secondary objective was to explore the effect of various demographic variables on the hourly wages of pharmacists. METHODS: Data were collected from 1,688 pharmacists in 6 states during 2003 using a cross-sectional descriptive survey design. A multiple regression analysis on hourly wage testing the effects of state of practice, practice setting, position, terminal degree, and years in practice was conducted. Subsequent multiple regression analyses were conducted individually for each of the 6 states to test the effects of the above variables on hourly wage for both male and female pharmacists, followed by state-level analyses for male and female pharmacists, respectively. RESULTS: For the pooled data, all variables were found to be significant predictors of hourly wage, except for earning a PharmD degree without a residency or graduate degree. Gender was not a significant predictor of wage disparities in the state-level analyses. Position was the only significant predictor of wage disparities in all states (except Tennessee) such that pharmacists in management positions make significantly higher salaries than those in staff positions. CONCLUSIONS: The results of these analyses suggest that wage disparities due to gender do not exist at the state level for the 6 states surveyed, when controlling for practice setting, position, terminal degree, and years in practice. The larger number of men in management positions may explain lower wages for female pharmacists.

Cross-Sectional Studies↗
PubMed2005

Osteoporosis beliefs and antiresorptive medication use.

OBJECTIVE: Although a number of prescription medications are effective for the prevention and treatment of osteoporosis, little is known about the role of beliefs and attitudes in women decisions to use these drugs. The objectives of this study were (1) to assess the role of beliefs and attitudes regarding osteoporosis and prescription antiresorptive drugs in the decision to use newer antiresorptive medicines (such as bis-phosphonates, selective estrogen receptor modulators, and calcitonin nasal) and (2) to assess the role of these same beliefs and attitudes in the decision to use hormone therapy. DESIGN: Data were collected using a cross-sectional survey mailed to 1700 community dwelling women age 45 and older residing in Minnesota. Respondents completed measures of health belief model constructs, medication profiles and demographics. Data were analyzed using multivariate logistic regression models. RESULTS: A total of 983 usable survey forms were returned, yielding an adjusted response rate of 60.7%. More than one quarter of respondents reported using a prescription antiresorptive agent, with 90 (9.2%) currently taking a newer antiresorptive agent and 163 (16.6%) using hormone therapy. Several health belief model components were predictive of newer antiresorptive medicine use, including higher perceptions of susceptibility to osteoporosis (OR 1.34, 95% CI 1.20-1.49), perceptions of strong benefits of antiresorptive medicines (OR 1.34, 95% CI 1.10-1.63), and perceptions of few barriers to the use of antiresorptive medicines (OR 0.51, 95% CI 0.38-0.67). Several cues to action also were predictive of newer antiresorptive medicine use. Use of hormone therapy was associated with a single cue to action (being tested for osteoporosis (OR 1.74, 95% CI 1.14-2.66) and the perception of few barriers to the use of prescription antiresorptives (OR 0.65, 95% CI 0.55-0.77). CONCLUSION: Several health belief model constructs were associated with the decision to use newer antiresorptive drugs relative to no prescription therapy. However, few model components as operationalized in this study were predictive of the use of hormone therapy. Although the health belief model appears to provide a plausible model of the decision to undertake newer antiresorptive drug therapy, it explains little about women use of hormone therapy.

Aged↗
PubMed2005

Factors influencing the shift of patients from one proton pump inhibitor to another: the effect of direct-to-consumer advertising.

BACKGROUND: Switching from one proton pump inhibitor (PPI) to another is common, and may be related to factors other than efficacy and tolerability. OBJECTIVES: The purposes of this study were to describe the incidence of therapeutic switching among PPI users, quantify direct ambulatory medical costs of switching, and characterize the relationship between product switching and variables hypothesized to influence a switch (eg, direct-to-consumer [DTC] advertising, structure of insurance coverage, disease diagnosis). METHODS: This was a retrospective cohort study of health plans using 1998 data. The subjects were employees and dependents with employer-sponsored health insurance contributing to the Medstat Market-Scan administrative dataset. Using a commercially available database to quantify DTC advertising by marketing area, market-specific expenditures were matched to eligible subjects. Among PPI users, we identified those who switched from one product to another (switchers) and compared their utilization and spending with nonswitchers. We then evaluated the relationship between drug use and variables hypothesized to affect switching: DTC advertising, insurance characteristics, patient diagnosis, diagnostic procedures, comorbidities, age, and sex. RESULTS: The analysis used data for 396,500 individuals from 47 unique markets that were geographically well distributed, with population density similar to that of the United States overall. The sample was also comparable with US census estimates for age and sex among working adults and their dependents. Only 620 (6.3%) of PPI users switched products during the 1998 calendar year. Annual diagnostic and drug costs were >US $400 higher for switchers than nonswitchers. Subjects in areas with high levels of DTC advertising were 43% more likely to switch from lansoprazole to omeprazole than those in the low-expenditure areas. Additionally, patients paying prescription drug copayments >US $5 were 12% less likely to switch from lansoprazole to omeprazole than patients paying lower copayments. CONCLUSIONS: In these privately insured patients using PPIs, product switching was associated with increased treatment costs. DTC advertising and patient cost-sharing were important predictors of product switching.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.

BACKGROUND: Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising. OBJECTIVE: To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising. METHODS: The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates. RESULTS: The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor. CONCLUSIONS: Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to influence drug use should be interpreted with caution in the presence of DTC advertising.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

Television advertisement format and the provision of risk information about prescription drug products.

BACKGROUND: Considerable attention has been afforded to analyzing the content of and assessing consumers' reaction to print direct-to-consumer drug ads, but not so for televised ads. OBJECTIVE: To determine whether advertisements with different risk severity and risk presentation would significantly affect viewers' (1) recall of information contained in the advertisement, (2) evaluation of the advertisement, and (3) perceptions of the advertised product's risks. METHODS: Data were collected from a sample of 135 first-year pharmacy students at a Midwestern college of pharmacy. After viewing 1 of the 6 advertisements designed for this study, participants were asked to complete a self-administered survey. Chi-square and analysis of variance were used to analyze the data. A 2x3 between subjects design was used to test the effects of 2 levels of risk severity (high- vs low-risk severity) and 3 levels of risk presentation (original ad containing integrated risk message, deintegrated risk message/dual modality using male voice-over, deintegrated risk message/dual modality using female voice-over). RESULTS: Results of analysis of variance procedures revealed that deintegrating risk information by placing it at the end of the advertisement and the use of captions in addition to oral messages (dual modality) (1) improved the recall of general and specific side effect information, (2) led to a perception that the advertisement had greater informational content, (3) resulted in lower Advertisement Distraction, and (4) lessened cognitive and affective aspects of information overload for the advertisement containing the high-risk severity medication. However, this pattern of findings was not found for the low-risk severity medication. CONCLUSION: Alternative methods for presenting risk information in direct-to-consumer ads affected some aspects of information recall and advertisement evaluation, but were not shown to affect risk perceptions regarding the advertised products.

Adult↗
PubMed2005

The study of direct-to-consumer advertising for prescription drugs.

OBJECTIVES: The objectives of this article are to (1) identify key methodological issues related to investigating the effects of direct-to-consumer advertising (DTCA) for prescription drugs, (2) highlight opportunities and challenges that these issues pose, and (3) provide suggestions to address these challenges and opportunities from a social and administrative pharmacy perspective. METHODS: Through a review of existing literature and consultation with research colleagues, we identified 3 broad issues regarding the study of DTCA for prescription drugs: (1) the importance of problem formulation, (2) the role of health behavior and decision-making perspectives, and (3) data collection and data analysis challenges and opportunities. Based upon our findings, we developed recommendations for future research in this area. RESULTS: Clear problem formulation will be instructive for prioritizing research needs and for determining the role that health behavior and decision-making perspectives can serve in DTCA research. In addition, it appears that cluster bias, nonlinear relationships, mediating/moderating effects, time effects, acquiescent response, and case mix are particularly salient challenges for the DTCA research domain. CONCLUSIONS: We suggest that problem formulation, selection of sound theories upon which to base research, and data collection and data analysis challenges are key methodological issues related to investigating the effects of DTCA for prescription drugs.

Advertising↗
PubMed2005

Distinguishing characteristics of patients who seek more information or request a prescription in response to direct-to-consumer advertisements.

OBJECTIVE: The objective of this study was to examine demographic and psychographic profiles of individuals who sought additional information or requested a prescription drug based on a direct-to-consumer advertisement. METHODS: A cross-sectional descriptive survey was used for collecting data from a random sample of 200 Minnesotans during Fall 2002. Chi-square and Mann-Whitney U tests were used as nonparametric tests for assessing differences in distributions between our categories of study subjects. RESULTS: Out of 177 deliverable surveys, 81 (46%) were returned. Of these, 80 surveys were usable for analysis. The results showed that the distinguishing characteristics of individuals who sought additional information based on an advertisement were associated with demographic variables such as number of drugs taken daily and monthly out-of-pocket expenditures for prescription drugs. In contrast, distinguishing characteristics of individuals who requested prescription drugs (in addition to seeking information) based on an advertisement were psychographic in nature such as (1) viewing themselves as having greater influence on their physician, (2) having a stronger relationship with their physician, (3) expressing greater satisfaction with their current therapy, (4) viewing prescriptions as less of a burden, and (5) having higher outcome expectations for prescription drugs compared to the respondents who did not ask for a prescription drug based on a direct-to-consumer advertisement. CONCLUSIONS: Distinguishing characteristics of information seekers were demographic in nature, whereas those characteristics of prescription requesters were psychographic in nature.

Advertising↗
PubMed2004

Morbidity and medication preferences of individuals with headache presenting to a community pharmacy.

OBJECTIVE: To assess the degree of debilitation and the treatment views of individuals with headache presenting to a community pharmacy. BACKGROUND: Migraine and chronic daily headache are common poorly managed illnesses. Pharmacists recommend an over-the-counter "headache product" to customers more than 53 000 times daily, thus they are well positioned to help those with headache. DESIGN: Pilot project of 22 self-administered surveys of individuals presenting to a community pharmacy with a complaint of headache. RESULTS: Thirteen persons had Migraine Disability Assessment scores of grade III or grade IV. Of the sample population, a substantial minority (41%) did not believe their headaches could be effectively managed with over-the-counter medications, 72% did not feel over-the-counter agents were safer than prescription products, 96% did not indicate that over-the-counter drugs were more effective than prescription drugs, and 50% disagreed that a physician's evaluation was not necessary. Only half of the population was satisfied with their current therapy, and individuals overwhelmingly (91%) wished they could prevent their headaches. CONCLUSIONS: The majority of individuals with headache presenting to a community pharmacy had high levels of morbidity and were in need of education regarding the proper role of over-the-counter medications, the advantages of prescription agents, and the benefits of a physician's referral. These preliminary results indicate that community pharmacies are potentially important locations for identification, education, and referral of individuals with headache.

Adolescent↗
PubMed2003

Construct identification and measure development for investigating pharmacist-patient relationships.

To investigate older adults' perceptions of pharmacist-patient relationships, we identified meaningful constructs, developed measures to use in this domain, and explored associations between pairs of constructs. Data were collected via mailed survey to a systematic random sample of 500 non-institutionalized adults in the United States, aged 65 years and older, taking at least one prescription medication. The usable response rate was 66.5% (330/496). Older adults' perceptions that the pharmacist is participating in the relationship and the relationship is patient-centered had the strongest association with perceived pharmacist-patient relationship quality. Older adults' perceptions of relationship quality had a stronger association with medication-related outcome expectations and self-efficacy for medication management, as compared to older adults' perceptions of pharmacist participative behavior/patient-centeredness, patient participative behavior and pharmacist-patient interpersonal communication. Older adults' perceptions of medication-related knowledge were moderately associated with self-efficacy for medication management perceptions. These findings have important pharmacy practice implications.

Aged↗
PubMed2002

Evaluation of pharmacists' services for hospital inpatients.

Patient satisfaction with pharmacist-conducted weekly medication-education classes and the underlying factor structure of the evaluation items are described. The pharmacist service consisted of weekly, one-hour classes for headache sufferers in a tertiary headache clinic's hospital unit. One pharmacist taught all of the classes and conducted them in the same manner each week, using the Indian Health Service patient-counseling technique. The classes included both lecture and one-on-one interactions. Any patient admitted to the hospital's headache unit was eligible to participate in the study. Patients were asked to complete a survey at the end of the class, evaluating the service in terms of performance, disconfirmation of expectations, affect, equity, and self-efficacy by rating three statements about each of these on a 7-point scale, where 1 = very strongly disagree and 7 = very strongly agree. Exploratory factor analysis was used to investigate the degree to which these five evaluation areas were distinct constructs. A total of 157 patients attended a medication-education class during the study period. Of these, 153 (97%) provided usable data. Respondents favorably evaluated the pharmacist service, as the means were significantly greater than the scales' midpoint scores (p < 0.001). Factor analysis results suggested that covariation in the data was best described by four factors rather than five: (1) performance, (2) disconfirmation of expectations, (3) equity, and (4) self-efficacy. Inpatients attending pharmacist-conducted weekly medication-education classes favorably evaluated the pharmacist service. Four different conceptualizations of patients' evaluations were identified.

Adolescent↗
PubMed2002

Interdisciplinary medication education in a church environment.

A medication education program for ambulatory care patients implemented in a church setting was studied. The program at each of 20 churches in Ohio consisted of a one-hour orientation for pharmacists/interns, a 20-minute presentation on medications and health, a question-and-answer session led by a pharmacist and a nurse, a one-on-one session with a pharmacist, and an exit interview with a nurse. Before the program, patients completed a form to assess their current experiences with medications and their interactions with health care professionals in the preceding six months. During an exit interview at the end of the program, patients were asked whether the program has been understandable and beneficial and whether taking medications affected their lifestyle. A follow-up interview was conducted six months later. A total of 187 patients completed both the exit and follow-up interviews. Almost all reported that the church setting was a good place for the program and that the program was beneficial. During the six months after the program, the patients took significantly fewer drugs each day than during the six months before the program and had fewer drug-related problems. Significantly more patients sought drug information after completing the program than before it. High rates of medication misuse were identified, leading to 359 pharmacist recommendations. An interdisciplinary program in a church setting successfully provided medication education.

Adult↗
PubMed2002

Exploring prescription drug coverage and drug use for older americans.

OBJECTIVE: To describe existing prescription drug insurance coverage for older Americans, to describe out-of-pocket payment levels per prescription associated with service benefit prescription drug plans used by older persons, and to examine the association of prescription drug coverage types with the reported use of prescription drugs by older persons. PATIENTS AND METHODS: Data were obtained from a national survey of 1570 community-dwelling older persons (>65 y) conducted in June 1998. A 2-part utilization model was estimated using logistic regression and ordinary least-squares regression. RESULTS: Data from 310 respondents were used for analysis. Overall, 66.1% of respondents reported having prescription drug insurance coverage. A majority (76.6%) of respondents having private drug coverage reported having a service benefit plan (requiring copayment or coinsurance amount to be paid for each prescription). The median copayment per brand name and generic prescription for persons reporting having coverage by service benefit plans was $10 and $5, respectively. CONCLUSIONS: Overall, a majority of older persons reported paying relatively small amounts out-of-pocket per prescription during 1998. Among persons who reported having drug insurance coverage, there were no statistically significant differences in the reported number of drugs used daily, regardless of out-of-pocket payment amount per prescription. Patient need and level of past drug use were significantly associated with both the likelihood of using any prescription drugs and the level of use among users. More research is needed to examine differences in drug expenditures and characteristics of drugs used across prescription drug insurance types for older persons.

Aged↗
PubMedDate not supplied

Community pharmacists' work activities in the United States during 2000.

OBJECTIVES: To describe community pharmacists' work activities in the United States during 2000 and to investigate the effects of position, pharmacy type, and prescription volume on work activities. DESIGN: Cross-sectional descriptive survey of a systematic sample of 4,895 U.S. pharmacists, of which 2,250 responded. SETTING: United States. PARTICIPANTS: A sample of 832 community pharmacists working full-time (at least 30 hours per week) out of the total of 2,250 who responded to the survey. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Workload (hours worked and proportion of prescriptions dispensed at the site with which the pharmacist was personally involved) and professional responsibilities (proportion of time spent in medication dispensing, consultation, business management, and drug use management). RESULTS: As of 2000, the typical community pharmacist in the United States devoted 56% of his or her time to medication dispensing responsibilities, 19% to consultation responsibilities, 16% to business management responsibilities, and 9% to drug use management responsibilities. These results were consistent for pharmacists regardless of pharmacy type or prescription volume; however, position did significantly affect the proportion of time spent in the various activities. CONCLUSION: Pharmacists are still devoting the majority of their time to medication dispensing responsibilities. However, our findings also show that pharmacists would prefer to devote more of their time to professional responsibilities, such as consultation and drug use management, and less time to medication dispensing and business management.

Adult↗