Biomedical subjects

Swu-Jane Lin

Publications and source records attributed to Swu-Jane Lin.

14 recordsLinked to original sources

PubMed2007

Implementing the Medicare drug benefit in a diverse inner-city community.

PURPOSE: An integrated effort to maintain continued access to pharmacy services and prescribed medications for patients in an inner-city community before and during the implementation of the Medicare prescription drug benefit is described. SUMMARY: An academic medical center and college of pharmacy in a culturally diverse, inner-city Chicago community created a strategy to provide uninterrupted pharmacy services to all of their Medicare Part D eligible patients, particularly those dual eligible for Medicaid and Medicare, during the transition from Medicaid to Medicare Part D, effective January 1, 2006. The percentage of dual-eligible patients in the Medicare Part D eligible population at the institution was more than twice the national average. A task force was created to prepare for the onset of Medicare Part D. The task force had goals in three areas: education, outreach, and operations; it was also responsible for the development of a contingency plan for any problems that could happen after January 1. A Medicare drug benefit consult service was formed to ensure that Medicare eligible patients understood the Medicare drug benefit and received customized assistance. Although problems were encountered, the investment in the preparation and implementation of the Medicare drug benefit, especially the consult service, resulted in a positive return on the institution's investment. Suggestions for other institutions facing the challenge of the implementation of the Medicare drug benefit are provided. CONCLUSION: Implementing a federal-level program among a diverse subset of patients is challenging and requires concerted efforts from health care providers and support from the institution. The Medicare drug benefit task force at the institution assumed responsibility for all pharmacy activities related to Medicare Part D and achieved its goals in education, outreach, and operations. This resulted in continued access to pharmacy services and prescribed medications for patients.

Adolescent↗

PubMed2006

Effects of a national medication education program in Taiwan to change the public's perceptions of the roles and functions of pharmacists.

OBJECTIVE: To evaluate the effect of a national medication education program on public's perceptions of the roles and functions of pharmacists in Taiwan. METHODS: This was a single group, pre- and post-comparison study. The subjects were 955 community residents enrolled in the Community Education Program on Medication Use (CEPMU) between September 2003 and January 2004 in Taiwan. The program was a pharmacist-facilitated national education program implemented at 31 community universities nationwide. The education program consisted of 14 lectures that were delivered over a 4-month period. A questionnaire was administered before and after the program to survey the subjects on their usual drug-information sources, their evaluation of the credibility of the drug-information sources, and their perceptions of the roles and functions of pharmacists in Taiwan. Paired t-test was used to analyze the difference between pre- and post-tests with a significant level set at 0.05 a priori. RESULTS: At the end of the program, the subjects were more likely to request drug information from healthcare professionals as compared to the baseline (p < 0.05). They also had more confidence in the information provided by the community pharmacists (p < 0.05) and had a better understanding of the roles and functions of pharmacists (p < 0.05). CONCLUSIONS: The national medication education program facilitated by pharmacists helps to direct the subjects to pharmacists or other healthcare givers for drug information. It also improves their perceptions of the roles and functions of pharmacists in Taiwan. PRACTICE IMPLICATIONS: Pharmacists' proactive participation in health education helped society to appreciate the roles and functions of pharmacists as knowledge workers in terms of drug information providers and safeguards of drug use.

Adult↗

PubMed2006

Appeals system and its outcomes in national health insurance in Taiwan.

BACKGROUND: Prior authorization has been used extensively as one of the mechanisms to control costs and ensure quality of care by the National Health Insurance (NHI) plan in Taiwan. An appeals system, the Dispute Mediation Committee (DMC), independent of the NHI, is available for interested parties to dispute denials of prior authorization. Currently, medications for Alzheimer's disease constitute the largest category of appeals. OBJECTIVE: To describe the appeals system and analyze outcomes of cases of medications for Alzheimer's disease submitted to the Bureau of NHI (BNHI) for prior authorization and to the DMC for appeals. METHODS: Prescriptions of donepezil and rivastigmine submitted for prior authorization from 2000 through 2002 were analyzed. Cases denied prior authorization and later submitted as appeals to the DMC were summarized with descriptive and bivariate methods. RESULTS: A total of 12,237 cases of donepezil and 6975 cases of rivastigmine were submitted to the BNHI for prior authorization; among them, 72.6% of donepezil and 66.5% of rivastigmine cases received authorization. Among the thousands of cases denied prior authorization, 124 appealed to the DMC for dispute resolution. The result of the majority of the appeals (111 [89.5%]) was to uphold the BNHI denial decision. Most of the appeals were denied because of the lack of appropriate exclusion of other possible causes of dementia. CONCLUSIONS: Most appeals were again denied after expert review. Better education concerning utilization guidelines and a platform for insurer, insuree, and physician to dialog are needed to improve the effectiveness and efficiency of the appeals system.

Adult↗

PubMed2006

Frequency estimates from prescription drug datasets (revision of #04-11-066A).

PURPOSE: Accurate information about the number of times a drug is prescribed or dispensed annually is important to marketers, pharmacoepidemiologists, and patient safety researchers. Yet there is no standard reference for prescribing frequency data. The multiple sources that do exist vary in their sampling methods, target populations, nomenclature, and methods of tallying individual medications prescribed or dispensed. These differences are likely to create ambiguity and contradictions in the scientific literature, but they are not well understood. METHODS: We conducted a descriptive study to examine the similarities and differences between five well-known sources of prescribing frequency data: the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS, emergency department and outpatient department), the IMS National Prescription Drug Audit, the Solucient outpatient dataset, and the Solucient inpatient dataset. We compared survey methods, costs, overall frequencies, number of unique names in each database, correlations between frequency estimates from different databases, the extent of overlap in the databases, and nomenclature differences between and within datasets. RESULTS: All the correlations between frequency estimates derived from different datasets were significant, but the frequency estimates differed considerably. The lowest correlation (0.17) was found between the IMS and emergency department of the NHAMCS, and the highest correlation (0.93) was between IMS and Solucient outpatient data. CONCLUSIONS: Although there were significant correlations between frequency estimates for comparable datasets, sampling methods and nomenclature choices resulted in important differences both for individual drug products and for overall frequency statistics. Researchers need to be aware of the differences when deriving drug frequency with these datasets.

Databases as Topic↗

PubMed2006

Trends in off-label beta-blocker use: a secondary data analysis.

BACKGROUND: The off-label use of beta-blockers might be prevalent, but no studies have provided empiric data on the off-label use based on utilization data. OBJECTIVE: This secondary data analysis was conducted to describe the trends of off-label use of beta-blockers among ambulatory visits made to office-based physicians in the United States. METHODS: Data from the National Ambulatory Medical Care Surveys from 1999 to 2002 were used in this study. Physician visits at which beta-blockers were prescribed (beta-blocker visits) were included and classified as within-label or off-label visits according to whether an approved indication for the beta-blocker was coded for the visits. Variables of patient demographic characteristics, diagnosis, prescriber's specialty, and concomitant medication use were also analyzed. Logistic regression analysis was employed to investigate the potential determinants for the off-label use of beta-blockers. RESULTS: A total of 3349 million visits were made to office-based physicians during the study period. About 65% (2167 million) of all visits were prescribed with > or =1 medication (medication visits). Beta-blockers were prescribed in 5.9% (127.3 million) of all medication visits in the years 1999 to 2002. The 3 most frequently prescribed beta-blockers in this study were atenolol, metoprolol, and propranolol. The proportions of off-label use among beta-blocker visits were 44.3% (1999), 56.3% (2000), 62.3% (2001), and 46.9% (2002); overall, 52.0% (66.2 million). About 11% (75.7 million) of these off-label uses were prescribed to patients with concomitant conditions that required judicious use of beta-blockers. Specialists, such as cardiologists, were more likely to prescribe beta-blockers for off-label use than primary care physicians (odds ratio, 2.147; 95% CI, 2.1464-2.1473). CONCLUSIONS: Our study found that the off-label use rate of beta-blockers was higher than what has been previously reported for other diseases and medications. Compared with visits made to general practitioners, visits made to specialists were more likely to be prescribed off-label use of beta-blockers. Future studies are needed to understand the legal, economic, and clinical impact of off-label use.

Adrenergic beta-Antagonists↗

PubMed2005

Effects of a national health education program on the medication knowledge of the public in Taiwan.

BACKGROUND: The inappropriate use of medication and inadequate medication knowledge among the general population has long been a concern in Taiwan. One reason for the deficiencies might be the lack of an active role of pharmacists in educating the public. To rectify the situation, in 2002, the Bureau of Pharmaceutical Affairs, Department of Health of Taiwan, began to sponsor a national effort, titled Community Education Program on Medication Use, to involve the expertise of pharmacists in public education. OBJECTIVE: To evaluate the effects of this education program by analyzing the changes in knowledge of drug therapy among the participating public. METHODS: This was a single-group pre- and post-comparison study. Between September 2003 and January 2004, a total of 955 community residents enrolled in the pharmacist-facilitated education program offered at 31 community universities. The medication knowledge of the participants was evaluated before and after the program. Demographic variables that might affect the education outcomes of the program were also examined. RESULTS: Medication knowledge at baseline was positively correlated with education level and negatively correlated with age. Females were more aware of drug-related information than were males. The participants showed a significant improvement in medication knowledge (p < 0.001) at the end of the program. The baseline knowledge score was the most important determinant of the improvement of the posttest score. CONCLUSIONS: A national education program facilitated by pharmacists can improve the medication knowledge of the participants. Pharmacists should be encouraged to play a proactive role in large-scale health education programs.

Adolescent↗

PubMed2005

Trend and area variation in amphetamine prescription usage among children and adolescents in Michigan.

The increased use of stimulant medications for children and teenagers is an ongoing issue of professional and public concern. Unlike methylphenidate, the growth of prescriptions and patterns of utilization of amphetamines for pediatric populations have not been well documented. The study objectives were to describe the trends of amphetamine prescription utilization among pediatric age groups in Michigan and to compare area variations. A population-based computerized data set from the state of Michigan was used to extract all outpatient prescriptions for Schedule II amphetamines dispensed from 1990 to 1997. The prescribing rates by age groups and by counties were computed with the projected population size of corresponding years, and mapped and analyzed with spatial statistical methods. Counties that did not conform to the global spatial dependence pattern in the prescription rate were identified using Moran scatter plot. A total of 236,661 outpatient prescriptions for amphetamines were dispensed in Michigan during the time frame, including less than 1% for methamphetamine, 24.5% for amphetamine, and 74.8% for dextroamphetamine. The prescribing rate was highest among children 10-14 years old (380 prescriptions per 10,000 people) in 1997, followed by children 5-9 years old (253 prescriptions per 10,000). Over the 8-year period, the prescribing rates of amphetamines increased significantly, ranging from 380% for children 2-4 years to 817% for teenagers older than 14 years. The rates among counties ranged from 60 to 1648 per 10,000 children 5-14 years old, with the highest prescribing rates in the northwestern regions of Michigan. Although spatial dependence explained 36% of the variance, the area variations that are unaccounted for are still considerable. In conclusion, there were substantial increases and unexplained area variations in amphetamine usage in Michigan during the study period. Both phenomena require awareness and evaluation from researchers, policy makers, clinicians, and the public.

Adolescent↗

PubMed2005

Potential access and revealed access to pain management medications.

The area configuration of healthcare resources, such as the number of hospitals per hundred thousand population, has often been used in healthcare planning and policy making to estimate the global access (potential access) of health services to a local population. However, the actual utilization of the "available" healthcare resources (revealed access) is usually much more limited. The objectives of this study were to examine the availability of healthcare resources by measuring the potential access and the revealed access for outpatients who need to access pharmacies to fill prescriptions of Schedule II (CII) opioids for pain management, and to explore the difference between rural and urban residents in these two types of access. About 191,700 prescriptions for CII opioids dispensed in 1997 in the state of Michigan, USA were analyzed. Revealed accessibility was measured by the distance between the paired zip codes of the pharmacy and the patient listed on each prescription. Potential accessibility was measured by the distance from a patient's zip code to that of the nearest community pharmacy that could dispense the opioid prescriptions. The analyses on revealed access showed that 50% of the CII prescriptions were dispensed by pharmacies located within a 5-mile radius of patients' residences, 75% of prescriptions were dispensed within about a 10-mile radius, and 90% were within 20 miles. If patients were free to access the nearest pharmacy for dispensing (a hypothetical situation under potential access), the median, 75th percentile, and 90th percentile distances could reduce to 2, 3, and 5 miles, respectively. Similar differences between revealed and potential access were observed in both rural and urban areas and for every major opioid drug group. We conclude that policymakers should recognize the discrepancy between potential and revealed accessibility and move beyond only considering area configuration of healthcare resources to evaluating and improving access to care.

Analgesics, Opioid↗

PubMed2005

Designing safe drug names.

Recent observational studies of medication errors in community pharmacies suggest that 'wrong drug' errors, which occur when a patient receives a drug other than the one prescribed, may occur as many as 3.9 million times per year in the US. Similarity between drug product attributes, especially similarity between drug names, is thought to be a contributing cause of these errors. The challenge facing drug companies is to design new drug names that will not be confused with existing names. In this paper, we attempt to lay out a systematic approach to the design of safe drug names by characterising the process of design as a multiple-objective optimisation problem. We then identify and define the most important constraints (both technical and legal/regulatory) and objectives (such as meaning, memorability, and pronouncability) that a drug name must satisfy and critique methods for evaluating a given name with respect to each safety objective and constraint. There are a variety of preapproval tests that can be done on a name to test its vulnerability to confusion. These include computerised searches for existing similar names or products, soliciting expert judgements, doing traditional psycholinguistic tests on memory and perception and observing error rates during simulated ordering, dispensing and administration tasks. A different set of strategies is needed to prevent confusion between similar names that are already in use. Preventing confusion between already marketed products typically involves collecting voluntary reports of names involved in confusion errors, posting warnings and alerts both electronically and in areas where drugs are used, including the indication on the prescription, storing confusing drugs in different locations, improving lighting, providing magnifiers, removing one of the confusing drugs from the system or insisting on double-checking for products thought to be vulnerable to confusion.Finally, since no single design will be optimal with respect to all of the objectives, we describe several approaches to selecting one design from a set of competing alternatives. The pharmaceutical industry and the US FDA have taken important steps recently to improve the preapproval screening of new drug names, but a great deal of research still needs to be done to establish a valid scientific basis for these decisions.

Confusion↗

PubMed2005

The impact of urinary incontinence on quality of life of the elderly.

OBJECTIVES: To investigate the impact of urinary incontinence (UI) on health-related quality of life (QOL), as measured by the Medical Outcomes Study Short Form-36 (SF-36) and to compare UI and non-UI elderly Medicare beneficiaries enrolled in managed care plans on the prevalence of depression and self-rated health. METHODS: After excluding beneficiaries younger than 65 years old, a total of 141 815 completed surveys were used for analysis. The survey included 1 question on difficulty in controlling urination, 3 questions on depression, 3 questions on health, a series of questions regarding comorbid medical conditions, and the SF-36. Self-rated health, prevalence of depression, and scores in each domain of QOL were compared between UI and non-UI groups. RESULTS: Overall, the prevalence of UI was 24.7% (20.9% in men, 27.5% in women). The UI group was about twice as likely to feel depressed as the non-UI group. The UI group also rated their health more negatively. Compared with continent respondents, those who were incontinent had lower standardized scores on all 8 subscales of SF-36 as well as 2 summary scores. Results from multiple regressions indicated that UI had a significantly negative impact on all aspects of QOL after adjusting for comorbidities and demographic differences. CONCLUSION: Findings indicate that elderly patients with UI are more depressed and have worse perceived health. On certain domains of QOL, the negative impact of UI even surpasses that of other severe comorbidities.

Aged↗

PubMed2004

Access to community pharmacies by the elderly in Illinois: a geographic information systems analysis.

Community pharmacies play an important role in maintaining population health in the United States. They are large in number, distribute widely across geographic areas, and operate for long hours. Because the elderly population tends to use more medications and have more frequent interaction with pharmacies and pharmacists, this study was carried out to understand the geographic access to community pharmacies by the elderly in Illinois and to estimate the disparity in the access between rural and urban areas. The addresses of all community pharmacies operating in 2001 were geocoded to identify their locations. The Census 2000 data on demographics at the census block group level was used to estimate the geographic distribution of the Illinois population by age group. Using the centroid of each census block group and the locations of community pharmacies, the distance to a nearest pharmacy for each census block group was calculated. The distance was then weighted to compute the aggregated distance required for the elderly to access a pharmacy. There were 1373 community pharmacies operating in Illinois in 2001. Most pharmacies (93.8%) were located in urban areas. On average, there were 1.27 and 0.38 pharmacies per 10,000 people in urban and rural areas, respectively. The average distance for an elderly person in Illinois to locate a community pharmacy was 0.9 miles in urban areas, but it was six times more (5.9 miles) in rural areas. At least 10% of the rural elderly had to travel more than 11.8 miles to find a community pharmacy, but only 0.1% had to travel more than 20 miles. The geographic access to community pharmacies appears to be appropriate in Illinois. However, a small portion of rural elderly who do not have a pharmacy in their nearby areas may warrant special attention.

Aged↗

PubMed2003

Immediate free recall of drug names: effects of similarity and availability.

The prescribing frequency, subjective familiarity, and two measures of similarity as predictors of error in immediate free recall of drug names were assessed. The study design utilized prospective, computer-based, word memory experiments in which 30 pharmacists and 66 college students were asked to immediately recall 15 lists of three three-syllable drug names. Intralist similarity was systematically varied. The number of words forgotten or incorrectly recalled was then examined as a function of similarity, subjective familiarity, and prescribing frequency. The primary outcome measure was the number of item errors in free recall. Pharmacists made fewer errors than college students. Familiarity reliably enhanced item recall among both pharmacists and college students. Prescribing frequency enhanced recall among both pharmacists and college students except when college students recalled generic names. Orthographic (i.e., spelling) similarity was reliably associated with item recall in both groups. Fewer errors were made when lists were more orthographically similar. Among pharmacists, there was an inverted U-shaped relationship between phonologic (i.e., sound) similarity and item errors, with the fewest errors being made on the most similar lists. Among college students, phonologic similarity was not reliably associated with item errors. Frequently prescribed and subjectively familiar drug names are more accurately recalled than rarely prescribed and unfamiliar names. Orthographically similar lists of drug names are easier to recall than dissimilar lists because similarity provides cues that facilitate the retrieval of degraded short-term memories. The effects of similarity, familiarity, and frequency on short-term memory of drug names vary as a function of task and stimulus characteristics.

Humans↗

PubMed2003

A patient empowerment model to prevent medication errors.

Each year, untold deaths occur because of medical and medication errors in the United States. In generally, most people have the naïve perception that the health-care enterprise is a fail-safe system and as such do not take proactive measures to prevent potential medication errors. This paper is timely in light of the proliferation of medication use in outpatient settings and thus warrants the education of patients to take the responsibility in proper drug use. Patients and the health-care professionals must understand the need to see patients as part of the health-care team to ensure quality of care and decrease medication errors. A patient empowerment model to prevent medication error is therefore proposed.

Humans↗

PubMedDate not supplied

The use of the occupational disruptiveness scale of the neuropsychiatric inventory-nursing home version to measure the impact of rivastigmine on the disruptive behavior of nursing home residents with Alzheimer's disease.

OBJECTIVES: The Neuropsychiatric Inventory-Nursing Home Version (NPI-NH) was used to study the impact of rivastigmine (Exelon; Novartis Pharmaceuticals Corporation, East Hanover, NJ), on occupational disruptiveness (OD), a proxy measure for professional caregiver burden. METHODS: The study was a prospective, multicenter, open-label, single-arm trial with NH residents prescribed rivastigmine (up to 6 mg bid) for Alzheimer's disease (AD) treatment. The NPI-NH was completed by NH staff caregivers at time of initiation of treatment with rivastigmine (T1), at treatment weeks 10 to 14 (T2), at treatment weeks 24 to 28 (T3), and at treatment weeks 50 to 54 (T4). RESULTS: Observations ranged from 173 at baseline to 73 at week 52. All but one patient had either moderate or severe dementia. Total OD score means were 4.7 +/- 6.1, 3.9 +/- 5.0, 4.19 +/- 5.6, and 2.79 +/- 2.8 at baseline, and weeks 12, 26, and 52 (T1-T4), respectively, with significant difference found between T1 and T4. Except for euphoria and disinhibition at T3 and T4, all correlations between OD scores and the domain scores of the NPI, were significant. Rivastigmine dose was an independent variable that affected OD change. CONCLUSION: Treatment with rivastigmine was associated with a reduction in the self-reported professional caregiver burden, as assessed by the NPI-NH OD scale.

Aged↗