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Introduction: Prescription opioid use is becoming increasingly common; consequently, opioid overdose deaths are increasing at an alarming rate. Hydrocodone, one of the most commonly abused opioids, was changed from a schedule III controlled substance to the more stringent schedule II to decrease abuse and diversion, effective Oct. 6, 2014. The objective of this study was to examine the impact of the hydrocodone schedule change on opioid prescribing in South Dakota. Methods: Opioid prescription patterns were examined in the following six-month phases: the baseline phase before the change, the transition phase when existing hydrocodone prescriptions could still be refilled, and the final phase. The South Dakota Board of Pharmacy Prescription Drug Monitoring Program provided aggregate monthly data for South Dakota opioid prescriptions (i.e., total number of prescriptions and days supplied), including urban and rural stratification. T-tests were performed on the monthly values for each phase to determine the significance of differences in prescription features between phases. Results: The number of hydrocodone prescriptions significantly decreased 14 percent from baseline to final phase, while the days supplied per prescription significantly increased 7.4 percent. These changes were greater in rural areas than in urban areas. Conversely, the number of other opioid prescriptions significantly increased by 6.5 percent over this timeframe. Conclusions: The number of hydrocodone prescriptions decreased, while the days supplied per prescription increased. These changes were greater in rural areas than in urban areas. In addition, the number of other opioid prescriptions increased. These trends may reflect some unintended effects of the schedule change. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Affordable Care Act (ACA) initiated federally and state-run health insurance exchanges, or marketplaces, with health plans offering subsidies for plan members as well as coverage for essential health benefits, to help individuals, families, and small businesses find health plans that fit their specific needs. A recent study found that the value of these healthcare subsidies varied with the number of health plans in the different geographic rating areas, but that study only examined the premiums and the deductibles of those health plans. OBJECTIVES: To examine the value of subsidies of health plans, including cost-sharing for prescription drugs in the health insurance marketplace. METHODS: We have used publicly available health plan data from HealthCare.gov and from county population data obtained from the US Census Bureau in June 2015. The average-weighted premium; medical deductible; medical maximum out-of-pocket spending; and cost-sharing for generic drugs, preferred and nonpreferred brand-name drugs, and specialty drugs were calculated for the second lowest-cost silver plan in each geographic rating area. These were then compared across geographic areas with different numbers of plans to determine the value of the subsidies. We also compared the difference between the cost of the average silver plan and the second lowest-cost silver plan for each area to determine the cost to enrollees if they selected the average silver plan. RESULTS: The monetary value of the subsidies provided by health plans was lower in areas with a larger number of plans, because the second lowest-cost silver plans in these areas tended to have lower premiums and higher deductibles. For the most common type of cost-sharing for generic and for preferred brand-name drugs, plan enrollees would likely have a lower or similar copayment if they selected the average-cost silver plan instead of the second lowest-cost silver plan. However, they may end up paying approximately $8 less in copayment for nonpreferred branded drugs and approximately 4% less for coinsurance after a deductible for specialty drugs if they resided in a geographic area with fewer than 11 plans. CONCLUSION: The value of subsidies provided by the ACA-initiated health plans in the healthcare marketplace, including cost-sharing for prescription drugs, varies across geographic areas with different numbers of health plans. This suggests that potential enrollees should consider cost-sharing for prescription drugs in addition to health plans' premiums and deductibles when choosing their health plan. [ABSTRACT FROM AUTHOR]

Objective: To describe patients' perceived value and use of quality measures in evaluating and choosing community pharmacies. Design: Focus group methodology was combined with a survey tool. During the focus groups, participants assessed the value of the Pharmacy Quality Alliance's quality measures in evaluating and choosing a pharmacy. Also, participants completed questionnaires rating their perceived value of quality measures in evaluating a pharmacy (1 being low value and 5 being high) or choosing a pharmacy (yes/no). Thematic analysis and descriptive statistics were used to analyse the focus groups and surveys, respectively. Setting: Semistructured focus groups were conducted in a private meeting space of an urban and a rural area of a Mid-western State in the USA. Participants: Thirty-four adults who filled prescription medications in community pharmacies for a chronic illness were recruited in community pharmacies, senior centres and public libraries. Results: While comments indicated that all measures were important, medication safety measures (eg, drug- drug interactions) were valued more highly than others. Rating of quality measure utility in evaluating a pharmacy ranged from a mean of 4.88 ('drug-drug interactions') to a mean of 4.0 ('absence of controller therapy for patients with asthma'). Patients were hesitant to use quality information in choosing a pharmacy (depending on the participant's location) but might consider if moving to a new area or having had a negative pharmacy experience. Use of select quality measures to choose a pharmacy ranged from 97.1% of participants using 'drug-drug interactions' (medication safety measure) to 55.9% using 'absence of controller therapy for patients with asthma'. Conclusions: The study participants valued quality measures in evaluating and selecting a community pharmacy, with medication safety measures valued highest. The participants reported that the quality measures would not typically cause a switch in pharmacy but might influence their selection in certain situations. [ABSTRACT FROM AUTHOR]

Background: Assessment using case based practical exams that require demonstration of clinical practice skills and articulation of clinical reasoning is commonly used in undergraduate allied health and nursing professions. However, the student often struggles in understanding and evaluating their performance of practical skills in preparation for summative practical assessment tasks. The fear of attempting and completing practical tasks does not contribute to learning. Any means of encouraging self evaluation, reflection and facilitating learning that is driven by the learner and not the assessor will contribute to the performance of the student in the short term and the practitioner in the future. Aims: This project used a mixed-methodological approach to explore the use of audio-visual technology to enhance 61 undergraduate physiotherapy students' practice of self evaluation and then sought to explore and understand the student experience of the activity and the teacher feedback provided. Findings: Themes relating to the students concerns, strengths and levels of self-confidence were identified. Reflection on the student feedback provided and the implications for teaching are also discussed. [ABSTRACT FROM AUTHOR]

In 2012, the Centers for Medicare & Medicaid Services (CMS) established a partnership among stakeholders to decrease the percentage of residents in nursing homes receiving an antipsychotic agent by 15 percent. This goal emanated from concerns including the large percentage of residents taking antipsychotic agents, the questionable use of antipsychotics (e.g., off-label use), the high cost of inappropriate antipsychotic use, and toxicity in patients with dementia (e.g., black box warning regarding mortality). The successful achievement of this goal is evaluated via quality measures, which are greatly influenced by changes in exclusion of residents from the population examined. The partnership is focused on optimizing use of antipsychotic agents by training clinicians on nonpharmacologic approaches, educating on the dangers of antipsychotic medication use and sharing data on antipsychotic medications. In South Dakota, these efforts have yielded a 12 percent relative reduction (21.3 percent to 18.7 percent) in the percent of residents prescribed antipsychotic agents from the second quarter of 2012 to the second quarter of 2013. Future efforts in South Dakota include a Nursing Home Quality Care Collaborative that involves the majority of facilities across the state learning from peers and national experts. The South Dakota Dementia Coalition includes 17 stakeholders who guide education activities and communicate these opportunities to their constituents. [ABSTRACT FROM AUTHOR]

Pain is frequently reported and often undertreated in the elderly population. In light of these concerns, it is important to examine potentially ineffective or problematic pain medications. Propoxyphene is one such agent whose efficacy and safety have been questioned by researchers, clinicians and the U.S. Food and Drug Administration (FDA). Specifically, multiple studies have found propoxyphene to be no more effective than acetaminophen (APAP), yet propoxyphene causes opioid side effects and has been involved in many drug-related deaths. In addition, propoxyphene/APAP products are often prescribed at doses that exceed maximum values (49.2 percent of APAP/ propoxyphene napsylate 100 prescriptions for South Dakota Medicaid patients exceeded the maximum daily dose). The relevance of propoxyphene use is seen by the 7.1 percent prevalence of propoxyphene prescriptions among the South Dakota Medicare beneficiaries, which is comparable to the 6.8 percent reported in the U.S. community-based Medicare population. Therefore, it is very important to consider alternatives to propoxyphene such as APAP, nonsteroidal anti-inflammatory drugs (rare use due to adverse effects) and other opioids, when managing elderly patients with pain. [ABSTRACT FROM AUTHOR]

The article presents the result of the study on the effect of the national trends and methods in reducing the use of antipsychotic medication in nursing homes in the U.S. It states that 60 percent reported improvements while 30 percent had not observed improvement in several areas including care planning, antipsychotic use decisions, and assessment of residents. It mentions that resource tool kits and best practice descriptions help guide efforts.

The article examines the importance of involving nursing home residents/residents' decision makers in the potential use of antipsychotic medications. Topics discussed include the standards that may be used in examining the appropriateness of prescribing antipsychotic agents, the common misperceptions about off-label prescribing practices, and the adverse effects of antipsychotic drugs. The use of antipsychotic agents for treating dementia-related behaviors is mentioned.

The article discusses the management of pressure ulcer pain. According to the author, the pain management for pressure ulcer should balance the side effects of treatment with complications of pain. Experts have recommended the first pain treatment measure to be nonsteroidal anti-inflammatory drugs (NSAIDs). Other options for managing pressure ulcer pain include opioids and oral medications.

The article talks about the concern for high dose acetaminophen. It provides a review of the acute liver failure (ALF) evidence and narcotic/acetaminophen combination product prescribing patterns in South Dakota's Medicaid population. From this study, it is clear that ALF from acetaminophen requires careful attention because acetaminophen causes many more cases of ALF than any other medication on the market, and the severity of ALF is great. It concludes that narcotic/acetaminophen products are effective choices in the management of pain, but unintentional use of acetaminophen has led to ALF in patients who most often used a single acetaminophen product.

Optimizing medication use through the evaluation of Potentially Inappropriate Medications (PIMs) has been the focus of a great deal of research. The Centers for Medicare & Medicaid Services (CMS) has created its own definition of PIMs from a variety of existing criteria and has contracted with each state's Quality Improvement Organization (South Dakota Foundation for Medical Care in South Dakota) to work on reducing PIM rates. In South Dakota, 16.4 percent of Medicare beneficiaries who filled a prescription (April 1, 2008, through September 30, 2008) received a PIM. Of the patients receiving PIMs, 13.6 percent received PIMs from two or more categories, and 88.3 percent filled a prescription for at least one of the five most common PIM categories. These five PIM categories were propoxyphene, skeletal muscle relaxants (select agents), nitrofurantoin, oral estrogens and antihistamines (select agents). While there may be rare occasions when these agents are justified, safer or more effective alternatives exist.

Decline among older adults has the potential to produce dramatic changes in the elderly person's life, having an influence on the place of residence, self-sufficiency, and quality of life. Although the prevalence of decline among the elderly had decreased, the relevance of this topic will continue to grow with the expansion of the elderly population. It is important to understand the terminology used to describe decline, how it is measured, its ramifications, associated risk factors, and potential causes in order to participate in preventing and managing decline. Pharmacists should also be aware of the relationship of medications to decline including the management of causative conditions and medication-use patterns that are associated with decline. Finally, pharmacists must be prepared to help elderly patients who are having difficulties administering medications as a result of decline.