Practice-Related Projects
Pharmacy Cost of Dispensing/Acquisition Cost Study. David Kreling, PhD., Principal Investigator. Awarded by the State of Wisconsin, DHFS. $45,471. 2000 - 2001.
This study has two objectives: 1) to estimate the cost of dispensing a prescription and 2) assess prescription drug acquisition costs in community pharmacies that participate in the Wisconsin Medicaid program. For the cost of dispensing component, pharmacy managers and/or chain pharmacy executives will be contacted to report financial and operational data for calculating the average cost of dispensing a prescription in their pharmacy(s). Approximately 600 pharmacies will be selected for the study based on the number of Medicaid claims paid to the pharmacies, with emphasis on higher claim volume pharmacies.
For the acquisition cost component of the study, a subset of pharmacies will submit one month's worth of prescription drug purchase invoices. Costs for selected target drugs (selected because they commonly are dispensed to Medicaid recipients) will be compared with reference prices to determine the percentage of pharmacy acquisition costs relative to Average Wholesale Prices (AWPs). The costs determined in the two parts of the study will be examined for differences across pharmacies associated with pharmacy characteristics (e.g., rural/urban, high/low volume, special services, etc.)
Evaluation of prescription drug information materials-2001. Bonnie Svarstad, PhD, Principal Investigator. Jeanine Mount, PhD, RPh, and Nathan Kanous, PharmD, Co-Investigators. Awarded by the National Association of Boards of Pharmacy and the U.S. DHHS PHS Food and Drug Administration. $161,770. 2000 - 2001.
This is a national study to evaluate the quality of written patient information provided with new prescriptions in community pharmacies. Shoppers presented four prescriptions at a random sample of 400 pharmacies in 50 states during spring 2001. If pharmacy staff provided patient information leaflets, they were accepted and mailed to UW-Madison for evaluation using a national expert panel and consumer evaluators in different states. Findings will be submitted to the FDA and public in spring 2002.
National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic and Practice Characteristics. David Mott, PhD, William Doucette, PhD, Caroline Gaither, PhD, Craig Pederson, PhD, Jon C. Schommer, PhD, Co-Principal Investigators. Awarded by the Pharmacy Manpower Project, Inc. $56,283. 2000.
The overall objective of this study was to obtain reliable information on demographic and practice characteristics of the pharmacist workforce in the United States during 2000. The survey was designed to collect such information from a nationally representative sample of 5,000 pharmacists. Specific goals of the study included: 1) describe the pharmacist workforce in the United States in terms of demographic and practice characteristics, 2) examine factors influencing hours worked annually by pharmacists, 3) describe work patterns in terms of setting and hours worked, 4) examine job satisfaction, and 5) document job turnover intentions and pharmacist work histories. The Pharmacy Manpower Project was a consortium of national pharmacy organizations which included the APhA, AACP, NACDS, ASHP, NCPA, AMCP, ACA, ASCP, BHPr, NABP, NCSPAE, NPhA, NWDA, PhRMA, and PTCB.
Core Disease State Documents. David Kreling, PhD, Principal Investigator. David Mott, PhD, and Patrick D. Meek, PharmD, Co-Principal Investigators. Awarded by Eli Lilly and Company. $15,000. 1999.
The purpose of this study was to review the literature describing Parkinson's disease and ALS to summarize available information about three aspects of each disease. The first aspect was characteristics of each disease (etiology, clinical presentation, diagnosis, disease progression, incidence, care seeking behavior, current therapy, treatment guidelines). Humanistic measurements (quality of life and health status) and economic measurements (patient costs and resource use) comprised the second and third aspects of each disease.
Evaluation of the Wisconsin Pharmacy Self-Inspection Project. Joseph B. Wiederholt, PhD, Principal Investigator, Jon C. Schommer PhD, and Thomas D. McGregor MBA, Co-Investigators. Funding support from Wisconsin Department of Regulation and Licensing and from an educational grant from Schering Pharmaceuticals. 1992 - 1994.
To address the problems of understanding and interpreting pharmacy legal regulations (e.g., pharmacist consultation), the Wisconsin Pharmacy Examining Board (PEB) implemented a self-assessment program. The voluntary program, titled the Wisconsin Pharmacy Self-Inspection Project had five goals: (1) To provide an effective vehicle for continuing education in the aspect of jurisprudence pertaining to pharmacy practice; (2) To provide an effective method of communication between the PEB and practicing pharmacists to identify areas needing interpretation and clarification; (3) To increase the PEB's visibility in its role as a consumer protection agency; (4) To provide practicing pharmacists with the opportunity to update practice procedures and the assurance that their procedures are in compliance with current regulations; and (5) To provide a vehicle for the PEB to identify expectations of pharmacy practice to the profession in a positive environment.
Of the 1,200 pharmacies (pharmacy managers) asked to participate, 80% did, and over 75% of the participants reported they had made changes in their practices to update practice procedures and improved compliance with regulations.
Analysis of Prescription Marketplace Parameters and Reimbursement. David Kreling, Principal Investigator. Funded by the National Association of Chain Drug Stores. $14,893. 1991 - 1992.
Reimbursement amounts that would result from different approaches for determining third-party prescription payment were compared with marketplace parameters (usual and customary (U&C) prices), and with each other to examine the effects of different methods or levels of reimbursement. Payment amounts under many potential scenarios were simulated for the market mix of prescriptions dispensed in community pharmacies that was represented by audit data on cash prescriptions dispensed in the pharmacies. Payment simulations included percentile caps on U&C prices and drug cost plus dispensing fee formulas, where drug cost estimates were based on varying discounts off of Average Wholesale Price (AWP) or varying percent mark-ups added to Wholesaler Acquisition Cost (WAC). To examine additional provisions typical in public (Medicaid) prescription drug programs, drug cost limits (FFP limits) and use of the lower of the calculated formula amount or U&C price ("lower of" clause) were added to the simulations.
With a given payment level as a standard or basis, it generally was possible to match the overall outcome of that payment with alternate methods of determining payment amounts. Payment methods that combined FFP ingredient cost payment limit and "lower of" provisions yielded the most conservative payment levels.
Estimating the Costs of Inappropriate Psychotropic Medication Use Among Nursing Home Patients. David Kreling, PhD, Principal Investigator. Funded by Graduate School, UW-Madison. $1,851. Summer 1988.
A method was developed to estimate direct costs of potentially inappropriate medication orders. Data from a previous qualitative study investigating the appropriateness of psychotropic drug orders among 760 nursing home residents in seven long-term care facilities in Wisconsin were used to exemplify the method. Direct costs were estimated by assigning the drug product cost for the number of units billed at Medicaid reimbursement rates and adding the Medicaid dispensing fee amounts.
Overall, 80.7% of the dollars spent for psychotropic drug orders in this population of nursing home residents may have been wasted due to potentially inappropriate use. Antipsychotic orders with potential errors associated with them had both the highest estimated total monthly cost ($2,318) and mean monthly cost ($13.72). The type of potential error with the greatest estimated monthly cost was drugs with no indication (no corresponding diagnosis on the medical chart).
Consultant Pharmacy Study. Jeanine Mount, PhD, Principal Investigator. Funded by the UW Graduate School and Sonderegger Research Center. $11,464. 1986 - 1988.
The quality of medication and dispensing in nursing homes has been a critical component of care quality. This study focused on 20 consultant pharmacists providing services to nursing homes. The role of the consultant pharmacist was examined in initiating change effectively when the pharmacist had a concern about a patient's medication. Specifically, the study examined the consultant pharmacist's role in reviewing prescriptions and communicating any medication concerns to other nursing home staff. The study coded who the pharmacist communicated with, the format of the communication, and the result of the communication. These variables were examined in relation to the organizational structure of the nursing home, the interprofessional relationships among staff associated with the nursing home, and resident care outcomes.
Three interviews were conducted with each consultant pharmacist, and data was collected from a variety of institutional records including: the consultant pharmacist's review of the "federal indicators"; nursing station inspection forms; medication problems identified by the provider pharmacy; minutes of Pharmacy and Therapeutics, Utilization Review and other facility committees (where accessible); and resident incident/accident reports.
Practice Economics in Community Pharmacies. David Kreling, PhD, Principal Investigator. Funded by Wisconsin Independent Community Pharmacists. $300. Fall 1989.
Pharmacy providers participating in prescription drug plans of HMO and third-party insurers have been offered contracts with changes in payments for prescriptions dispensed to beneficiaries. Payments have been reduced in attempts to control costs for the drug component of coverage HMOs and insurers provide. Pharmacist costs of providing services were analyzed in relation to potential revenues from third-party reimbursements for a small, pilot sample of nine pharmacies. Cost of dispensing was estimated from data gathered from pharmacists via a brief self-report questionnaire. Revenues were estimated for 100 prescriptions [approximately 50 single source (brand) and 50 multi-source (generic) prescriptions] dispensed in the pharmacies. Existing and proposed reimbursement formulas were applied to the 100 prescriptions (drug cost plus fee formula) and the resulting gross margins were compared with the cost of dispensing for the pharmacies.
Predicting Sleep Medication Use in Nursing Homes. Bonnie Svarstad, PhD, Principal Investigator. Funded by the National Institute on Aging, NIH. $140,000. 1985-1988.
The purpose of this study was to examine the resident, nurse, and facility factors that affect the nature and quality of sleep medication use in nursing homes. Over 2,000 residents in 18 randomly selected skilled nursing facilities were studied using medical and pharmacy records, nurse surveys, and observational data. Findings showed that the quality of psychoactive drugs use was better in facilities with a resident-centered treatment culture and better nurse staffing. The study also found that resident depression, pain, and demand for medication played a significant role in whether or not the resident received benzodiazepine medications on a chronic basis. A follow-up study was done in the same facilities after implementation of stricter federal regulations. Results showed that antipsychotic drug use declined as a result of stricter regulations; however, stricter regulations had no effect on the prevalence or chronic use of benzodiazepines, antidepressants, or polymedicine.
Graduate Explorer Monograph Project, Joseph Wiederholt, PhD, Principal Investigator. Funded by Glaxo. $7,500. 1993 - 1996.
A career guide was developed for pharmacy graduates entering a profession associated with Social Administrative Sciences rather than pharmacy practice. The Guide gives definitions of subdisciplines and the nature of careers available. Examples include pharmaceutical marketing, pharmacy law, and informatics. The guide was piloted-tested and evaluated in 12 Schools of Pharmacy.