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Objectives This study aims to understand acceptable strategies to enhance the COVID-19 vaccine uptake among mothers who have no intention to vaccinate their children. Methods In a cross-sectional study, using an online survey in March 2021, we evaluated the variables within the Health Belief Model (severity, susceptibility, benefits, barriers and cues to action) along with parents’ sociodemographic characteristics, previous COVID-19 infection, job loss due to COVID-19 pandemic and the presence of healthcare workers among the household. Total number of children in the household and their chronic health conditions were also assessed. Multivariable logistic regression was performed to evaluate the intention to vaccinate children against the COVID-19 and associations with other variables. Key findings The survey response rate was 32.30% (595/1842). Most of the participants were White (72.1%), 31–40 years old (55.46%) and married or in a cohabiting relationship (90.25). Out of 595 mothers with 3–15 years old children, 38.32% had no intention to vaccinate their children. Top factors associated with intention were perceived susceptibility (P = 0.002), benefits (P < 0.001), barriers (P < 0.001), cues to action (P < 0.001) and the presence of healthcare workers in the household (P = 0.032). The main barriers were concerns about vaccine safety, efficacy and side effects. The strongest cue to action was enough information being provided followed by doctors’ recommendations. Conclusions Strategies to increase vaccination for children lie in the process of convincing parents with providing reliable information on the vaccine safety, efficacy and side effects by paediatricians and other healthcare providers.

Students’ course performance is fundamental for any institution to carry out its academic mission. Often, in-class disengagement and lack of after-class course support in large-enrollment classes trigger academic problems for students. This leads to poor exam performance and an increased rate of final letter grade of a D or F or student withdrawal (DFW), an indicator of students’ poor academic success. Changing teaching strategies by using interventions that incorporate student-student interaction and student-faculty interaction may offer the opportunity to improve course performance. In this retrospective study, we examined the effect of changing teaching strategies on student course performance of 5,553 students enrolled in an undergraduate health sciences course over a span of 20 semesters. Three different interventions namely 1) daily low-stake in-class quizzes, 2) team-based learning, and 3) after-class review sessions were incorporated as teaching strategies. To assess the combined effect of these strategies’ students’ performance in the intervention period (12 semesters) was compared with control period (8 semesters). Student performance in the course was measured by exam grades; overall score; percentage of students receiving letter grades and A, B, C; and DFW rates. The data indicated that in the intervention period, exam scores increased by 6.6%, overall course score increased by 6.2%, percentage of students receiving letter grade A/B increased by 21.3%, percentage of students receiving letter grade C decreased by 6.9%, and the DFW rates decreased by 14.5%. Overall, changing teaching strategies through incorporation of these interventions improved students’ performance in the course.

Patients with chronic obstructive pulmonary disease (COPD) need long-term use of COPD medications to manage their conditions. However, COPD patients enrolling in Medicare Advantage plans (MAPs) may enter the coverage gap, resulting in increasing financial burden. The purpose of this study was to identify characteristics of COPD patients who enter the Medicare coverage gap and the factors associated with time to enter the coverage gap. A retrospective cross-sectional study was conducted using a Texas MAP database between 2011 and 2014. Patients aged ≥65 years with a diagnosis of COPD and taking medication to treat COPD were included. Patients were divided into mainly 2 groups: "no gap" versus "gap," based on their pharmacy outpatient spending. Within "gap," patients were further categorized into "coverage gap" and gap with "catastrophic coverage." Multinomial logistic regression was conducted to identify characteristics associated with reaching "coverage gap" and "catastrophic coverage." Cox proportional hazards were performed to evaluate factors associated with time to reaching "coverage gap." A total of 3142 COPD patients were identified: "no gap" (79%) and "gap" (21%). Among patients in "gap," 51% fell into "catastrophic coverage." Age, low-income subsidy (LIS) level, and Centers for MedicareMedicaid (CMS) risk score were significant factors associated with entering both "coverage gap" and "catastrophic coverage." Younger age, greater CMS risk score, and higher LIS benefit were associated with a higher hazard ratio of reaching the coverage gap. These characteristics may assist health maintenance organizations to identify beneficiaries who can potentially be provided with services with or without counseling on drug utilization.

To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors.The most recently available (years 2016-2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes-related complications, and total days absent from school or work change from baseline.1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes-related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes-related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization.Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes-related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.

Purpose With over 14,000 pharmacy graduates in 2019 in the United States, the pharmacy job market may be steadily becoming saturated. As part of the quality indicators, many Doctor of Pharmacy (PharmD) programs report and encourage their graduates to pursue residencies. However, there is a portion of the pharmacy students that are undecided about residencies. The purpose of this study was to learn about contributing factors that leads students to being undecided regarding considering residency programs. Method This was a survey-based study of year two and three pharmacy students from five Colleges of Pharmacy in the United States, conducted retrospectively. This study compared students’ past behaviors, attitudes, subjective norms and perceived behavioral control between students who were undecided and those with an Intent to Pursue (ITP) residency. Results A total of 287 students responded to the survey (response rate = 24.78%). Students that had not attended Midyear/residency showcase were more likely to be undecided about residencies than those that did (91.67% vs 62.50%). In addition, undecided students were less likely to agree that the people who were important to them believed that they should pursue residency compared to ITP group (4.36 vs. 5.72, on a 7-point Likert score). Lastly, those who perceived large student loans or family obligations as barriers were more likely to be undecided (OR 1.761 and 1.560, respectively). Discussion Focusing on undecided students and addressing these major contributing factors as part of the career advising/preparation may result in shifting these students’ intention to pursue residency.

Acceptance of chiropractic services as an effective therapy for neck or back pain has been well established with randomized controlled trials (RCTs); however, there have been limited observations made on the treatment frequency patterns seen in the real world.The purpose of this study is to identify chiropractic users with neck or back pain who did not meet recommended treatment frequency guidelines and examine their demographics and chiropractic costs.In this cross-sectional retrospective study, the nationally representative 2017 Medical Expenditure Panel Survey database was used.This study used nationally representative US survey data.Inclusion criteria were adults aged 18 years and older with a diagnosis of neck or back pain with one or more chiropractic visits in 2017.Chiropractic utilization was categorized as concordant or discordant with treatment frequency guidelines; concordant was defined as 5 or more visits to a chiropractor within any 2-month time frame or at least 12 total visits during the year. Discordant was defined as circumstances not meeting concordant criteria. The groups were compared by demographics including age, sex, race, region, years of education, health insurance coverage, employment status, family income, presence of headache diagnosis, Charlson Comorbidity Index score and the presence of any limitation of physical function. Comparisons were made between the two groups using Chi-squared tests. Logistic regression was used to adjust for covariates.There were 159 and 310 adults classified as concordant and discordant, respectively (weighted total: 1 849 108 [31.44%] and 4 032 541 [68.56%], with significantly different mean chiropractic costs of $2555 and $434, respectively. Significant independent predictors of discordant chiropractic utilization were race, years of education, family income and the presence of any limitation of physical function.Most chiropractic users with diagnosed neck or back pain were considered discordant with treatment frequency guidelines, which may indicate inefficiencies in treatment and inefficient use of healthcare resources.

During the coronavirus disease 2019 pandemic, pediatric vaccination rates for routine childhood vaccines have been declining. To boost pediatric immunizations, pharmacists in the United States may order and administer age-appropriate vaccines to children of 3 years of age and older without a prescription.The objective of this study was to examine parents' intention to have their young children between 3 and 10 years of age vaccinated in a community pharmacy setting.A survey instrument was designed based on the health belief model (HBM). The cross-sectional survey was administered online via Qualtrics Panels to parents in the United States with at least 1 child between the ages of 3 and 10 years. Confirmatory factor analysis was used to estimate the correlation between each of the HBM constructs and a 3-item scale measuring parents' intention to have their children between the ages of 3 and 10 vaccinated in a community pharmacy.There were 416 usable responses collected for an effective response rate of 25.95%. Most participants were white (79.09%) and female (51.44%), and many had a graduate degree (48.32%). More than half of parents (69.7%) indicated they would be willing to have their child vaccinated in a community pharmacy. Intention to have their child vaccinated in a pharmacy was most strongly corrected with health benefit beliefs (ψ 0.79 [95% CI 0.75-0.83]), (ψ 0.86 [95% CI 0.83-0.89])cues to action, and perceived convenience.(ψ 0.71 [95% CI 0.66-0.76]).Many parents have high intention to vaccinate their young children in community pharmacies. Parents should be educated and informed about services that community pharmacies offer. Stakeholders need to engage in interventions targeted at promoting health benefits of getting vaccinations at a pharmacy and strong recommendations from health care providers.

Objective: This study evaluated medication counseling procedures and trends at retail pharmacies in the Houston metropolitan area through a naturalistic observational study. Methods: A blinded cross-sectional observational study was conducted at retail pharmacies in the Houston metropolitan area. Data were collected by trained observers utilizing an observational log, to record various parameters that could have an impact on the duration of patient-pharmacist interaction in a naturalistic pharmacy practice setting. Additionally, indicators of counseling such as utilization of the counseling window and performance of show-and-tell were recorded. Statistical analyses included descriptive statistics, t-tests, Pearson correlations, ANOVAs, and multiple linear regressions. Results: One hundred and sixty-five interactions between patients and pharmacy staff were recorded at 45 retail pharmacies from 7 retail pharmacy chains. The counseling window was utilized in only 3 (1.81%) out of 165 observations and the show-and-tell process was observed in just 1(0.61%) interaction during this study. Mean (SD) interaction time between patient and pharmacists [159.50 (84.50)] was not statistically different (p>0.05) from the mean interaction time between patients and pharmacy technicians [139.30 (74.19)], irrespective of type of the retail chain observed. However, it was influenced by the number of patients waiting in queue. Patient wait time significantly differed by the time of the day the interaction was observed, weekends and weekdays had significantly different wait times and patient interaction times Multiple linear regression analyses indicated that, patient interaction time, pharmacy chain type, initial contact (pharmacist/technician), and time of the day, were significantly associated with patient wait time whereas patient wait time, pharmacy chain type, number of patients in queue, and number of pharmacy technician were significantly associated with interaction time. Conclusions: Our study found that the key indicators of counseling including the use of the counseling window and the show-and-tell process were absent, suggesting lack of adequate pharmacists counseling. Further studies are needed to evaluate the validity of this conclusion and the role of pharmacy services and its value towards medication use and safety.

BACKGROUND: Several medications, including long-acting bronchodilators (LABDs), are critical to the management of chronic obstructive pulmonary disease (COPD). Clinical guidelines recommend the initiation of an LABD for COPD posthospitalization to prevent exacerbations. COPD can limit a patient's exercise tolerance, mobility, and ability to work. Disease exacerbations resulting from inadequate treatment have contributed to increased medical costs and morbidity. OBJECTIVES: To analyze the prescription fills for COPD medications, especially LABDs, before and after COPD-related hospitalization, in elderly patients, and to evaluate factors associated with prescription fills of LABDs after COPD-related hospitalization. METHODS: This retrospective cohort study included patients with COPD aged ≥65 years who enrolled in Cigna-HealthSpring Medicare Advantage plans in Texas between 2011 and 2014. The index hospitalization was the first hospitalization with a primary diagnosis of COPD. Based on prescription fills within 180 days of the postindex discharge date, eligible patients were divided into 4 groups, by types of medication used. Prescription fills were compared during the 180-day preindex admission and 180-day postindex discharge. RESULTS: Of the 1352 patients included, 12% received LABDs and 26% received any COPD medication. The LABD group versus the no-LABD group and the COPD medication group versus the no-COPD medication group were more likely to have a higher Charlson Comorbidity Index (CCI) score. McNemar's tests indicated that the proportions of patients who filled any COPD medication prescription increased from before to after hospitalization. Overall, 69% of patients did not fill any COPD medication during the study period. Adjusted analysis indicated that patients with a higher CCI score who filled an LABD prescription or at least 1 other COPD medication within 180 days before hospitalization were more likely to fill an LABD prescription after hospitalization; filling an inhaled corticosteroid (ICS) prescription before hospitalization was associated with not filling an LABD prescription after hospitalization. CONCLUSIONS: Although filling an LABD and other COPD medications increased after hospitalization, the overall prescription fills for LABDs according to clinical guidelines was low in elderly patients. Patients with COPD who underutilized LABDs for maintenance therapy and relied more on ICSs before hospitalization were less likely to fill a prescription for an LABD after hospitalization. Future studies should evaluate patients' reasons for medication underutilization.

OBJECTIVE To compare three over-the-counter (OTC) Drug Facts panel versions for information processing optimization among college students. PARTICIPANTS University of Houston students (N = 210) participated in a cross-sectional survey from January to May 2010. METHODS A current FDA label was compared to two experimental labels developed using the theory of CHREST to test information processing by re-positioning the warning information within the Drug Facts panel. Congruency was defined as placing like information together. Information processing was evaluated using the OTC medication Label Evaluation Process Model (LEPM): label comprehension, ease-of-use, attitude toward the product, product evaluation, and purchase intention. RESULTS Experimental label with chunked congruent information (uses-directions-other information-warnings) was rated significantly higher than the current FDA label and had the best average scores among the LEPM information processing variables. CONCLUSION If replications uphold these findings, the FDA label design might be revised to improve information processing.

Introduction The physical activity (PA) behavior and its association with academic performance has not been examined among professional pharmacy (PharmD) students in didactic years. Methods A survey was administered to a cohort of PharmD students at University of Houston that collected information related to each student's PA and grade point average (GPA). Correlation analyses and multiple regression were performed to evaluate factors associated with GPA. Results The response rate was 58.1%. Stepwise multiple regression indicated that learning capacity and gender were major predictors for GPA. There was no significant association between PA and GPA. Discussion and conclusions Higher learning capacity and lower body mass index (BMI) were associated with higher GPA in PharmD students in their didactic years. Strategies such as engaging students in moderate to vigorous PA may enhance learning capacity and lower BMI; this may further positively influence students’ GPA. In addition to an emphasis on academic competence, pharmacy education that can better incorporate exercise would help students establish regular PA behaviors. This may improve their health outcomes and facilitate future patient counseling practices.

Objectives: There is great amount of evidence available indicating high emotional distress during the COVID19 pandemic. The goal of this study was to evaluate the emotional well-being of pharmacy students several months from the COVID19 pandemic in the US. Methods: A retrospective study was designed to evaluate the effect of pandemic on second, third- and fourth-year Doctor of Pharmacy (PharmD) students. Data was obtained from an online survey conducted once in November 2019 and once in November 2020. The survey consisted of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62) questionnaire. Subscales from CCAPS-62 considered in this study included depression, general anxiety (GA), hostility and substance abuse (SA). Raw scores for each subscale was categorized into healthy and clinical. A logistic regression model, adjusted for gender, race, class and physical activity was used to find any association between the pandemic and the probability of each subscale. Results: Overall, 305 and 159 students participated in 2019 and 2020 respectively. Majority of students were female and Asian. The results of adjusted regression model did not show any significant changes in the probability of depression, GA and SA between 2019 and 2020. However, a decrease in hostility was observed (OR=0.66 95%CI=0.43-o.997) in 2020. Conclusions: Contrary to previous studies, our study did not indicate increases in depression, general anxiety, hostility and substance abuse during the pandemic. The difference can be explained by the difference in the design of studies and the different data analysis. Previous studies were mostly cross-sectional and did not have a chance to evaluate the emotional state of the participants after controlling for other factors.

Objectives The purpose of this study was to evaluate the association between patients’ perceived relationship with their pharmacist and physicians and its association with their beliefs in medicine. Methods A cross-sectional design was used and 307 self-administered surveys were collected from adults, 45 years and above, in Houston, Texas via convenience sampling. Participants reported their general beliefs in medicine (perceived harm, perceived benefit and perceived medication overuse), perceived patient–pharmacist relationship, and perceived patient–physician relationship using a previously validated instrument adapted for this research. Perceived relationship constructs consisted of three domains each for pharmacist and physicians, namely trust/satisfaction, information sharing and patient involvement in treatment. Key findings The study participants were white (46.25%) females (54.72%) with a mean age of 58 (±13) years. The results indicate that the participants trusted and were satisfied with both their pharmacist and physician. Participants with higher trust/satisfaction with pharmacist consider medications as more beneficial. While participants with higher trust/satisfaction with their physicians were less likely to believe that doctors over-prescribe medicines, which may lead to medication over use. Information sharing by pharmacists was associated with a significant decrease in perception of general benefits of medications. Further participant's involvement in treatment decisions by the physician had a significant association with increased perceptions of benefits of medications. Conclusions Patients trust/satisfaction with their pharmacist leads to the belief that medications are more beneficial while a higher trust/satisfaction with physicians leads to lower beliefs in medicine, especially patients less likely to be adherent with appropriate medications.

The objective of this study was to examine the association between parenting stress and functional impairment among children with Neurodevelopmental Disorder (NDD). A sample of 150 parents of children diagnosed with NDD were recruited from schools that offer special education services. Parents completed a self-administered survey containing the parenting stress index-short form (PSI-SF) scale and the Columbia Impairment Scale. The multiple logistic regression conducted to compare those with clinically significant PSI-SF scores indicated that the risk of parents with clinically significant scores of parenting stress increased 5.5 times with functionally impaired children with NDD. Further the risk of stress increased 4.6 times when these parents reported having their own disorder/disease. The risk of stress was reduced by 57% for those who had higher than a college level education compared to those with a college level education or below. These findings might help health care providers to initiate early intervention strategies such as peer support and education that can prevent parenting stress and reduce the risk of potential incidence of depression.

The current literature has identified many motivating factors and barriers influencing pharmacy students' decision to apply for residency training. Despite a growing need for residency trained pharmacists to advance the profession, it is not clear why only about one in four pharmacy students decide to pursue a residency, and which of these factors have the most influence on student decision-making. The study examines the factors associated with pharmacy students' intention to apply for a postgraduate residency using the theory of planned behavior (TPB) framework.Second and third-year students from four Texas pharmacy schools were surveyed using an online questionnaire based on the TPB. Descriptive statistics and multiple linear regression analyses were utilized to assess the study objectives.A total of 251 completed responses were received. Attitude, subjective norms (SN), and perceived behavioral control (PBC) were significant predictors of intention to apply for a pharmacy residency (β = 0.32, 0.58, and 0.36, respectively, p0.001). Attending ASHP's midyear meeting or other residency showcase was a significant predictor of intention (β = 0.71, p = 0.006). Additional significant predictors of intention include believing a residency would increase confidence in practicing pharmacy (β = 0.36, p0.001) and help achieve career goals (β = 0.16, p0.02); the social influence of faculty members (β = 0.10, p = 0.003) and family (β = 0.08, p = 0.02); believing financial obligations (β = 0.20, p = 0.006), feeling afraid of the competition and/or not matching (β = 0.24, p0.001), needing to relocate (β = 0.09, p = 0.04), and the lengthy application and/or interview process (β = 0.12, p = 0.04) would make it more difficult to apply for a residency.The TPB model was useful in predicting pharmacy students' intention to apply for a residency, and all TPB constructs were significant predictors. Therefore, interventions that target students' attitude, SN, and PBC may be valuable to increase their intention, especially the specific beliefs identified to significantly predict intention. Future research into methods in which these motivating factors can be encouraged and perceived barriers can be addressed by pharmacy stakeholders will increase interest and participation in residency training.

Self-care and self-medication practices are essential components of any health care systems. The use of over-the-counter (OTC) medications is a part of the self-medication process. The popularity of OTC medication use among patients may increase the abuse potential of OTC medications. With pharmacists being as accessible as they are, they are often the first line of contact for patients, and have the opportunity to educate and counsel patients on appropriate OTC medication use. The presence of a pharmacist ensures safe and effective use of OTC medications. Pharmacists can liaise with other health care providers in the management of self-care practices by patients. However, a pharmacist has traditionally been underutilized in this role. This article provides a brief review on OTC medications with abuse potential and the effect of self-medication on OTC medication abuse. This review further describes the barriers faced by pharmacists in OTC medication abuse management, given the increased potential of prescription-to-OTC switch in recent years. In addition, the potential for a behind-the-counter drug category to boost patient-pharmacist interaction was discussed. The current review supports the positive role played by pharmacists in the management of OTC medication abuse. This review adds to the knowledge base of the barriers faced by pharmacists to prevent OTC medication abuse while developing appropriate intervention strategies. By expanding the role of pharmacists, OTC medication abuse may be controlled more effectively, thereby providing better patient medication therapy management and outcomes.

Low adherence to oral antidiabetic drugs (OADs) in the Medicare population can greatly reduce Centers for MedicareMedicaid Services (CMS) star ratings for managed care organizations (MCOs).To develop and validate a risk assessment tool (Prescription Medication Adherence Prediction Tool for Diabetes Medications [RxAPT-D]) to predict nonadherence to OADs using Medicare claims data.In this retrospective observational study, claims data for members enrolled in a Medicare Advantage Prescription Drug (MA-PD) program in Houston, Texas, were used. Data from 2012 (baseline period) were used to identify key variables to predict adherence in 2013 (follow-up period). Members aged 65 years and older with a diabetes diagnosis, at least 1 prescription for OADs (biguanides, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, or meglitinides), and continuously enrolled for both years were included in the study. Patients with insulin prescriptions were excluded from the cohort. The study outcome, nonadherence in 2013, was defined as proportion of days covered (PDC)80%. Multivariable logistic models using 200 bootstrap replications (with replacement) identified factors associated with nonadherence. The final model was tested for discrimination and calibration statistics and internally validated using 10-fold cross-validation. Using weighted beta coefficients of the predictors, the RxAPT-D was created to stratify nonadherence risk and was tested for sensitivity, specificity, positive prediction value, and negative prediction value. The predictive ability of the tool was compared with that of past PDC values using net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.Data from 7,028 MA-PD members were used for tool development. Seven predictors (age, total OAD refills, total OAD classes filled, days supply of last filled OAD, pill burden, coverage of last filled OAD, and past adherence) statistically significant in ≥ 50% of the bootstrapped samples were identified from the logistic models. The final model demonstrated good discrimination (c-statistics = 0.75) and calibration (Hosmer-Lemeshow goodness-of-fit P0.05) statistics, with good internal validity (area under the curve = 0.73). The RxAPT-D demonstrated adequate sensitivity statistics: sensitivity = 0.73, specificity = 0.63, positive prediction value = 0.74, and negative prediction value = 0.62. Compared with use of past adherence measures, the RxAPT-D had higher prediction ability, relative IDI = 2.09, and user defined NRI = 0.16 with 24% events correctly reclassified.The RxAPT is an effective tool to identify patients who are likely to become nonadherent to OADs in the follow-up year. Pharmacists in MCOs can use this tool to identify patients expected to be nonadherent to OADs and develop targeted intervention programs to assist in improving MCO CMS star ratings.This study received unrestricted partial funding from the Pharmaceutical Research and Manufacturers of America (PhRMA) Foundation Adherence Research Starter Award. Serna is employed by Cigna-HealthSpring. Mhatre is now employed with Genentech. The authors report no other potential conflicts of interest. The material in this study is based on work supported (or supported in part) by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. The abstract for this article was presented at the Academy of Managed Care Pharmacy's 28th Annual MeetingExpo, April 2016, San Francisco, California, with the title "Development and Validation of a Tool to Predict Nonadherence to Oral Antidiabetic Drugs in Medicare Beneficiaries." Study concept and design were primarily contributed by Sujit Sansgiry and Mhatre, with assistance from the other authors. Mhatre, Serna, and Sujit Sansgiry took the lead in data collection, assisted by the other authors, and data interpretation was performed by Mhatre, Shubhada Sansgiry, and Essien, assisted by the other authors. The manuscript was written by Mhatre and Fleming, assisted by the other authors, and revised primarily by Mhatre, along with Sujit Sansgiry and assisted by the other authors.

Introduction This study aimed to develop and evaluate new variables for assessment of doctor of pharmacy (PharmD) program candidates. Methods Two new admissions variables were created. The life experiences variable included number of awards, letter of reference scores, degree attainment, publications, prior academic suspension, leadership experience, work experience, and a diversity score. The holistic composite variable consisted of Pharmacy College Admission Test score, pre-pharmacy grade point average (GPA), interview score, and the new life experiences score. Variables were retroactively applied to prior admissions data, and scores of successful applicants were compared to scores of unsuccessful applicants. Results A total of 968 applicants from the 2015 and 2016 applicant pools were included in the evaluation analysis. Applicants offered admission had higher average scores for life experiences and holistic composite variables compared to those that were not offered admission (63.6 vs. 59.95 and 77.3 vs. 64, respectively). The life experiences and holistic composite scores were positively correlated with an offer of admission (0.142 and 0.547, respectively) and post-admission GPA (0.211 and 0.433, respectively) and negatively correlated with applicants accepting the offer of admission (−0.158 and − 0.25, respectively). Conclusions The holistic composite score was strongly predictive of an offer for admission and post-admission academic success, indicating that it may be a useful tool in assessing applicants. As new data becomes available, revisions could be considered to the life experiences score to better predict offer of an interview, offer of admission, and post-admission academic success.

Due to rising misuse, the Drug Enforcement Administration (DEA) moved hydrocodone combination products (HCPs) from DEA Schedule III to DEA Schedule II in October 2014. Aside from increasing regulatory scrutiny, rescheduling may have increased the administrative burden surrounding HCP prescribing. This study explored how HCP rescheduling and associated administrative barriers may have affected physician treatment of acute (aNCP) and chronic (cNCP) noncancer pain. To this end, physician members of the Texas Medical Association completed a self-administered online questionnaire. Pharmacotherapy treatment plan was measured with two questions asking physicians whether they were more likely to recommend HCPs, acetaminophen/codeine (APAP/codeine), nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, or other agents for the treatment of aNCP and cNCP. Two Likert-scaled items were used to assess administrative burden. In total, 1365 physicians responded (response rate = 15.39%). Physicians more frequently selected APAP/codeine (37%) for aNCP and tramadol (44%) for cNCP. A majority (78.8%) of physicians agreed that rescheduling led to modified prescribing, and those in agreement were significantly less likely than those who disagreed to prescribe HCPs for aNCP (24.2% vs. 56.4%; χ

This cross-sectional analysis evaluated the association of A1C control/variability with treatment patterns and outcomes in adult pts with T1D.The association of A1C control (categorized into

Objective. To examine the prevalence of general anxiety among Doctor of Pharmacy (PharmD) students and the role of academic distress and family distress in causing general anxiety. Methods. A cross-sectional study was conducted among first, second, and third year PharmD students. All students received an online survey consisting of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62) questionnaire and sample characteristics. Variables from CCAPS-62 considered in this study included academic distress and family distress measured on a three-level scale: no, low, and high clinical level. Data on gender, race, work status, and physical activity were also collected. Descriptive and multinomial logistic regression were conducted to identify factors associated with general anxiety. Results. Of the 238 students who took the online survey (63% response rate), the majority were female (67%) and Asian (49%). Overall, 69 first year, 75 second year, and 94 third year students participated. The prevalence of general anxiety was 50%, with equal distribution (25% each) among high-clinical and low-clinical general anxiety groups. High academic distress and high family distress were associated with a greater probability of a student having high general anxiety. Conclusion. General anxiety was quite prevalent among pharmacy students. Identification and implementation of strategies to lower general anxiety as well as academic distress is of great importance. Also, understanding and enhancing the role of family members in students’ lives is essential. College administrators can provide support for students as well as for family members to make improvements in these areas.

Objectives The aim of this study was to determine the predictors of the willingness to quit smoking among a cohort of male Saudi students. Methods In this cross-sectional study, a questionnaire was administered to a cohort of male students that were recruited from three institutes of higher education. Using the retrieved data, bivariate analysis and logistic regression tests were performed to assess the factors associated with the willingness to quit smoking. Results Of 467 participants, 24% of respondents were current smokers, while 65% of these smokers were willing to quit smoking. In the bivariate analysis, past attempts to quit smoking and the anti-smoking messages on TV and in newspapers were significantly associated with the willingness to quit smoking. Only one variable – past attempts to quit smoking – was a significant predictor of the willingness to quit smoking, as shown by the multivariate logistic regression analysis. Conclusion The findings of this study indicate that Saudi male students who smoke are willing to quit smoking; having unsuccessfully attempted to quit smoking in the past, they are willing to try again. Successful programs should be developed for male university students in KSA to assist them in their quest to quit smoking and maintain cessation.

Background Inappropriate use of acetaminophen products is a concern due to the severe liver damage associated with intentional or accidental overdose of these products. In 2009, the U.S. Food and Drug Administration (FDA) issued more severe organ-specific warnings for the acetaminophen Drug Facts label to improve protective behavior among patients. However, it is not clear how patients react to such interventions by the FDA. Objective The objective of this study was to evaluate the factors influencing patients' intention to engage in protective behavior while using acetaminophen products after reading the Drug Facts label. The study specifically looked at the relationship between four Protection Motivation Theory-based risk cognition factors and the intention to engage in protective behavior. Methods An experimental, cross-sectional, field study was conducted using self-administered questionnaires at four community pharmacies in Houston, TX. Two hundred surveys were collected from adults visiting the selected pharmacy stores. Participants were exposed to a simulated label (i.e. Drug Facts label) containing organ-specific warnings for over-the-counter (OTC) acetaminophen products. Risk cognition measures (i.e. measures of perceived severity, perceived vulnerability, response efficacy, and self-efficacy) and measures of intention to engage in protective behavior (always reading warnings, using products with more caution, and consulting a pharmacist/physician) were recorded. Pearson correlation and multiple linear regression analyses, controlling for demographic and behavioral characteristics of the participants, were performed. Results Bivariate analyses indicated that an increase in perceived severity, perceived vulnerability and response efficacy were associated with a higher intention to engage in protective behavior. Findings from the multiple regression indicated that increase in perceived severity of liver damage, belonging to a non-healthcare occupation, no history of acetaminophen use and no history of alcohol consumption were associated with a higher intention to engage in protective behavior. Conclusion Higher risk cognition of liver damage associated with inappropriate use of OTC acetaminophen products leads to greater intention to engage in protective behavior while using such products. Developing interventions targeted towards improving reading and adhering to the Drug Facts label could improve risk cognition, and thus improve patients' intention to engage in protective behavior. Regular acetaminophen users, heavy alcohol consumers and healthcare professionals might need other interventions apart from the Drug Facts label to improve their likelihood to engage in protective behavior.

Prescription medication adherence is a known health-related barrier for elderly patients, leading to insufficient disease control and negative health outcomes. The Centers for MedicareMedicaid Services (CMS) have placed significant emphasis on medication adherence, through the Part D star measures, revolving around treatment for chronic disease states such as hypertension, diabetes, and hyperlipidemia. However, it is unclear if physicians fully grasp the extent of nonadherence within their patient populations with regard to these medications, specifically those patients enrolled in Medicare Advantage Prescription Drug (MA-PD) plans.To (a) determine physicians' perceptions of medication adherence among their patients enrolled in MA-PD plans and (b) compare those perceptions with actual adherence rates obtained from claims data.A survey was developed and administered to primary care physicians (PCPs) contracted within a Texas MA-PD plan. The previously validated questionnaire was distributed during an all-PCP quarterly meeting and was collected prior to the meeting's conclusion to increase completion and return rates. PCPs were requested to indicate what percentage of their patients they believed to be adherent to each of the CMS Part D star medication classes, which includes statins, oral antidiabetic drugs (OADs), and reninangiotensin system (RAS) antagonists; what financial category they believe the majority of their patients fall under; and what percentage of their patients receive samples. The PCPs' perceived percentage of adherent patients were compared with the calculated percentage of patients, using a chi-square test at an a priori alpha level of 0.05. The calculated adherence was obtained from pharmacy claims data, meeting the CMS targeted adherence threshold (≥ 80%). This adherence rate was calculated using proportion of days covered (PDC) for all 3 medication categories in each PCP's patient population.To compare PCP perception of patient adherence and actual adherence, 226 PCPs were used. The sample population shared similar sex and age distribution with the national physician average; however, there was more racial diversity represented. PCP perception of patient adherence, as well as the actual percentage of adherent patients, were significantly (P0.05) different across statins, OADs, and RAS antagonists; lowest perceived percentage, as well as actual percentage, were reported for statins. PCP perception of patient adherence and actual percentage of adherent patients were significantly different in the 3 medication categories. PCPs' correct estimations were significantly (P0.0001) lower than expected values, while over- and underestimations were significantly (P0.0001) higher than the expected values.PCPs were almost equally likely to over- or underestimate percentage of adherent patients in their patient pools.

Background: Diabetic retinopathy, nephropathy and neuropathy in patients with type 1 diabetes (T1D) are microvascular complications that can adversely impact disease prognosis and incur greater healthcare costs. Early identification of patients at risk of these microvascular complications using predictive models through machine learning (ML) can be helpful in T1D management. The objective of current review was to systematically identify and summarize published predictive models that used ML to assess the risk of diabetic nephropathy, retinopathy and neuropathy in T1D patients. Methods: A targeted review of English literature was undertaken in PubMed (http://www.ncbi.nlm.nih. gov/pubmed) and Google Scholar (http://scholar.google.com/) from January 1, 2016 to May 31, 2019. Eligible articles were also identified from cross-references. Following concepts were used in combination to conduct the search queries: diabetes, retinopathy, nephropathy, neuropathy, microvascular complication, risk/predictive model, and ML/artificial intelligence/data mining. Results: A total of 3,769 hits were found from all sources combined, duplicates were removed, titles and abstracts were screened, 61 studies underwent full-text review and a total of six studies met the eligibility criteria. Among them, four studies had developed risk models using data obtained from T1D patients alone, whereas two used data from both T1D and type 2 diabetes (T2D) patients. There was only one study that evaluated all three types of microvascular complications while the other five focused on one individual complication, i.e., either diabetic retinopathy, nephropathy or neuropathy. Only two studies evaluated time to developing a complication. The other four studies assessed complications as either binary (yes/no) or categorical (multiple levels). Prediction models were built using cross-sectional data from survey questionnaire (n=1, Iran) and longitudinal data (n=5) which were further classified as sources of electronic medical records (EMR) (n=3, US: 1, Europe: 2), clinical trial (n=1, US) and prospective study (n=1, Europe). Common predictors across studies as well as across types of microvascular complications included age, gender, diabetes duration, BMI, blood pressure, lipid level, and mean or a single HbA1C value. Commonly used ML algorithms included classification and regression tree (CART) and random forest (RF) (CART/RF, n=3), support vector machines (SVMs, n=2), logistic regression (LR, n=2) and neural networks (NNs, n=1). Model performance was evaluated using area under curve (AUC, n=4) and accuracy (n=2). Only half (n=3) of the included studies tested their developed models in an external dataset of patients with T1D. Conclusions: Overall, very few studies reported predictive models for diabetic retinopathy, nephropathy and neuropathy using ML specifically for T1D patients. Future research that utilizes contemporary clinical data from T1D patients to predict the three types of microvascular complications is needed.

To test the effect of current versus 2 experimental label formats on information processing among current and potential over-the-counter (OTC) users.A cross-sectional survey was conducted in a cohort of adults across a metropolitan community, Houston, Texas. Three labels were designed. We placed a chunk of like information together (uses, direction, other information). Label A (control) followed the format of the existing FDA Drug Facts panel format for an antiallergy medication, label B had warnings placed before, while label C had warnings placed after the chunk. The 2 label designs were compared using the information-processing constructs derived from the OTC Label Evaluation Process Model (LEPM).A multivariate analysis of covariance and Dunnett's test revealed that the mean scores for constructs of OTC LEPM were significantly better for label C compared to the control and label B ( P.0001).Our label format improved information processing among consumers but only when warning placement was placed at the end in the Drug Facts panel, giving an opportunity for the FDA to consider revising the format of the OTC Drug Facts panel, to improve patient understanding and reciprocally enhance patient safety.

The US FDA is proposing an expanded over-the-counter (OTC) medication policy to improve patient access to medications under the supervision of a pharmacist. Higher levels of medication access via multiple medication categories are common in other industrialized nations. Pharmacists are well trained and widely available. Expanding medication access can help alleviate the physician shortage by directing patients with appropriate health conditions that can be managed with medication to community pharmacists. Examples include migraine headaches and seasonal allergies, which have a significant impact on patients’ quality of life and work productivity. Clinically relevant medications and dosages should be selected. Medication use guidelines should not be so restrictive as to defeat the policy intent. The proposed FDA policy is a long-overdue change that will help optimize available health personnel resources for patient care.

To evaluate the association between the Medicare coverage gap with hospitalization, emergency room (ER) visits, and time to hospitalization in chronic obstructive pulmonary disease (COPD) patients.Retrospective cohort study using data from a Medicare Advantage (MA) plan. Patients with ≥1 claim for COPD at baseline, ≥65 years, continuous 24-months enrollment and without any cancer/end stage renal disease diagnosis were eligible. Patients not reaching the coverage gap (no coverage gap) were matched and compared to those reaching the coverage gap and those reaching catastrophic coverage in separate analyses. Chi-square tests and Cox proportional hazards model were used to compare outcomes across matched cohorts.In total, 3142 COPD patients were identified (79% no coverage gap, 10% coverage gap, and 11% catastrophic coverage). Compared to the no coverage gap group, a larger number of beneficiaries in the coverage gap group had ≥1 hospitalization (26% vs 32%, p .05), ≥ 1 ER visits (43% vs 49%, p .05), and ≥1 hospitalization/ER (total visit) (47% vs 54%, p .05), respectively. Compared to the no coverage gap group, a greater number of beneficiaries in catastrophic coverage had ≥1 ER visit (45% vs 53%, p .05) or ≥1 total visits (48% vs 56%, p .05), respectively. Time to hospitalization was shorter among those entering the coverage gap as compared to the no coverage gap [Hazards Ratio (HR) = 1.5; p = .040].COPD patients entering the coverage gap and catastrophic coverage were associated with increased utilization of healthcare services. Entering the coverage gap was also associated with shorter time to hospitalization as compared to the no coverage gap.

The objective of this study was to develop a one-page (1-page) prescription drug information leaflet (PILs) and assess their impact on the information processing variables, across 2 levels of patient involvement.One-page PILs were developed using cognitive principles to lower mental effort and improve comprehension. An experimental, 3 × 2 repeated measures study was conducted to determine the impact of cognitive effort, manipulated using leaflet type on comprehension across 2 levels (high/low) of patient involvement. Adults (≥18 years) in a university setting in Houston were recruited for the study. Each participant was exposed to 3 different types of prescription drug information leaflet (the current practice, preexisting 1-page text-only, and 1-page PILs) for the 3 drugs (Celebrex, Ventolin HFA, Prezista) for a given involvement scenario. A prevalidated survey instrument was used to measure product knowledge, attitude toward leaflet, and intention to read.Multivariate analysis of variance indicated significant positive effect of cognitive effort, involvement, and their interaction effect across all measured variables. Mean scores for product knowledge, attitude toward leaflet, and intention to read were highest for PILs ( P.001), indicating that PILs exerted lowest cognitive effort. Univariate and post hoc analysis indicate that product knowledge significantly increases with high involvement.Patients reading PILs have higher comprehension compared with the current practice and text-only prototype leaflets evaluated. Higher levels of involvement further improve participant knowledge about the drug, increase their intention to read the leaflet, and change their attitude toward the leaflet. Implementation of PILs would improve information processing for consumers by reducing their cognitive effort.

The study aimed to identify predictors of selection for on-site interview and admission into the doctor of pharmacy (PharmD) program using variables from the Pharmacy College Application Service (PharmCAS).Admission data (de-identified) was obtained from University of Houston's College of Pharmacy for the years 2015 and 2016. The data consisted of relevant variables from the PharmCAS application system for all applicants during 2015 and 2016 admission cycles. Primary dependent variables were the admission committee decisions of (i) selection for on-site interview and (ii) admission into PharmD program. Descriptive frequency distributions, bivariate and multivariable logistic regression analyses were conducted to identify the predictors of admission decisions.A total of 968 completed application records were obtained out of which 651 were selected for on-site interview and 413 were offered admission into the PharmD program. The logistic regression analyses indicated that as compared to pre-pharmacy grade-point-average (GPA) score of3.2, applicants with a score of 3.2-3.49 (C.I 2.52-9.66) and ≥3.5 (C.I. 2.49-12.42) were more likely to be selected for interview. Applicants with pharmacy college admissions test (PCAT) score of 70-79 (C.I. 3.37-13.96) and ≥80 (C.I. 7.73-33.83) were more likely to be selected for interview as compared to those with PCAT 70. With respect to admissions, female gender (C.I. 1.01-2.12), pre-pharmacy GPA ≥ 3.5 (C.I. 1.62-4.82), PCAT ≥ 80 (C.I. 2.33-6.61), letters of reference score ≥ 3.7 (C.I. 1.04-2.29) and at least one known additional language (C.I. 0.47-0.99) influenced the likelihood of being admitted into the PharmD program.The study findings can be used to optimize the applicant review process by assigning more weightage to the significant predictors in decision making towards admission into PharmD programs. Future studies evaluating the influence of the predictors on academic performance are warranted.