Class of 2009 / OBJECTIVES: To compare the attitudes of community pharmacy managers who did and did not contract with Mirixa to provide Medicare Part D medication therapy management (MTM) services in 2006. METHODS: Design: Cross-sectional descriptive study. Setting: United States in 2006. Participants: 100 pharmacy managers contracted to provide MTM services in 2006 and 100 pharmacy managers not contracted to provide MTM services in 2006. Intervention: Telephone-administered survey of independent community pharmacy managers. Main outcome measures: Pharmacist knowledge of and attitudes toward Medicare Part D MTM services. RESULTS: 200 pharmacy managers completed the study (n = 100 for each group). Pharmacists who contracted with Mirixa to provide MTM services in 2006 were more familiar with Medicare Part D MTM (80% vs. 59%, P = 0.001). Significantly more pharmacists contracted with Mirixa to provide MTM services agreed that they were qualified to provide MTM services (96% vs. 88%, P = 0.01) and strongly agreed that an annual personal medication review would benefit patient outcomes (59% vs. 45%, P = 0.04). No significant difference was found between groups with regard to other variables addressed in the survey. CONCLUSIONS: Results of this study suggest that familiarity with Medicare Part D MTM services was a key factor in whether pharmacists chose to contract to provide MTM in 2006. Additionally, significantly more pharmacists who contracted felt strongly that personal medication reviews would improve patient outcomes.

Class of 2012 Abstract / Specific Aims: To assess physician approval of the MTM services provided. Specifically, to compare cost saving, guideline adherence, and safety concern interventions. Methods: A retrospective analysis of pharmacist interventions was performed using the MMC database for 2008. Data were collected on the type of intervention and approval by physicians. Physician specialty was also collected from state medical boards. Descriptive statistics were used to generate frequencies of approvals. Chi-square tests were used to compare physician approval by intervention type. Main Results: Pharmacists initiated 1,563 interventions that were faxed to physicians for approval. Of these interventions, cost saving, guideline adherence, and safety concerns were 33.2, 58.3, and 8.5 percent, respectively. Interventions primarily targeted diabetes (38.6%), cardiovascular disease (28.8%), gastroesophageal reflux disease (13.1%), and respiratory disease (8.4%). Physician approval for cost saving, guideline adherence, and safety concerns were 58.0, 44.4, and 41.0 percent, respectively. Approval for cost saving was greater than guideline adherence (58.0% versus 41.0%, P<0.001) and safety concerns (58.0% versus 44.4%, P=0.005). Approval among primary care physicians (PCP) compared to specialty physicians was greater for both cost saving (60.6% versus 50.7%, P=0.046) and guideline adherence (43.2% versus 36.2%, P=0.045) interventions. Conclusions: Results of this investigation provide evidence that there are differences in the types of MTM interventions that physicians will approve. In an effort to improve patient outcomes, this finding suggests a potential to increase overall physician approval of pharmacist-initiated MTM interventions in the areas of guideline adherence and safety concerns. Results further suggest that lower approval by specialists compared to PCPs may call for alternative methods to better reach these providers.

Class of 2008 Abstract / Objectives: The purpose of this study was to identify how community pharmacies have integrated medication therapy management (MTM) programs into their workflow and specifically determine the changes that were made in order to deliver such services. Methods: This was a descriptive study on the implementation of MTM programs in community pharmacies. Pharmacy managers associated with Cardinal Health, Medicine Shoppe International, United Drugs, the Iowa Pharmacy Association (IPA) and 10 additional selected pharmacists were invited to take an online survey regarding MTM program implementation in their pharmacy. Exclusion criteria were those pharmacists that did not provide any MTM services from January 2006 through December 2007. The primary dependent variables included time spent training, time to complete clinical pharmacy program sessions, scheduling and implementing clinical pharmacy sessions, staffing, and cost for additional equipment. Data analysis included percents and frequencies for categorical variables addressed in the internet survey. Results: Pharmacists that participated in this survey were mostly male (82%) and had been practicing for greater than 10 years. Only 3 out of 17 participants were female and all were a part of the group practicing for less than 10 years. The majority of participants in both groups completed 0-2 MTM sessions per week (p=0.65). In order to complete these sessions, the hiring of additional staff was not required (82%) nor was the purchase of additional equipment (70%). Conclusions: The implementation of MTM programs in community pharmacies requires little to no additional time or money. With this data, more pharmacists should be inclined to provide MTM sessions.

Each year, corporate America spends millions of dollars on leadership training programs in an attempt to create more effective managers, but many specialists in this field have speculated that much of this effort is wasted. In the past ten years, a small group of researchers have been approaching this issue from a different perspective; they are looking at how leaders think and create meaning in their roles. The purpose of this study is to contribute to that growing body of research by: (a) exploring the connections between concepts of transformational and transactional leadership models as defined by James MacGregor Burns and Bernard Bass, double-loop learning, a managerial model, as defined by Chris Argyris, and social cognitive development as defined and measured by Robert Kegan and Lawrence Kohlberg; (b) investigating how workers experience a range of leadership models. Eight leaders in a mid-sized, natural food distribution company comprised the primary research sample; eighteen employees also participated in the study via informal interviews. The Multifactor Leadership Questionnaire was used to determine the range of transformational abilities and in addition, each leader was assessed using two social cognitive tools: Robert Kegan's subject-object interview and the Defining Issues Test created by James Rest to assess moral reasoning abilities. Workers were interviewed to see how they experienced their environment and themes were culled from their responses. The results of the study suggested a relationship between the cognitive developmental level of the leaders as measured by Robert Kegan's stages and their transformational leadership abilities. Four out of five leaders used transformational skills with a fairly high degree of frequency. Worker interviews seemed to reflect a substantial degree of satisfaction with the organization. Four themes were extrapolated from the employee interviews: company as community/family, lack of hierarchy, informal atmosphere, and freedom to voice opposition. The implication of the study suggests that the ability to practice transformational leadership is strongly connected to an individual's social cognitive complexity and when this kind of leadership is practiced, the employees reported positive effects.

No description available.

Dietetic professionals integrate knowledge and expertise in food, nutrition, management and people and apply their skills in a variety of settings. As the changing scene in health care has necessitated enhanced management of resources, the clinical nutrition manager (CNM) has emerged as a dietetic professional in hospitals applying sound management practices to the area of clinical nutrition services. The purpose of this study was to provide information about the position of clinical nutrition manager and about the professional development strategies used by incumbents. The research design had two phases. The purpose of the first phase was to develop a job description for the position of clinical nutrition manager, including duties/activities and job specifications for education, experience and professional credentialing. The purpose of the second phase was to verify the accuracy of the job description, determine educational and experiential resources used to develop the required skills and knowledge for performing the duties/activities, and collect other descriptive data about the position. The result was a job description for a Clinical Nutrition Manager with 46 duties/activities assigned to the position and job specifications for work experience and academic preparation. Chi square analysis was used to test the association of the performance of a duty/activity with amount of time allotted to the position; number of personnel supervised; and type of personnel supervised. Results indicated that type of personnel supervised had the most significant association. One sample chi square analysis indicated that entry-level education and entry-level experience were the less likely resources to be used for development of skills and knowledge. For more than 50% of the duties/activities, the number of resources used was significantly related to the perceived level of importance. There was no significant finding for an association between timing of career decision to become a CNM and career development strategies intentionally selected. Findings also indicated that perceived competence improves with increasing number of years in the position and is not affected by having an advanced degree. / Graduation date: 1992

No description available.

Class of 2015 Abstract / Objectives: Quantify how many interventions were made during a pilot MTM program at a Costco pharmacy and assess patients’ attitudes towards MTM services offered at their local pharmacy. Methods: Contacted patients by phone and offered MTM services over 10 weeks. The patients are insured patients referred by Outcomes MTM and filled at least 50% of medications at Costco. Successful interventions were tallied and questionnaires administered to collect data on patients’ background knowledge of MTM, rating of how helpful and beneficial MTM services conducted by local pharmacy were, how frequent patients would like such services, how much they were willing to pay for such services, and demographic information. Results: Due to low response rate no meaningful statistical differences were able to be observed. However interesting trends started to emerge; more adherence related interventions, adequate compensation for a dedicated MTM pharmacist, and that MTM is unknown to most patients but do find it useful. Additionally we were able to observe challenges and difficulties with implementing MTM services at a store level. Conclusions: The original aim of the study was not able to be adequately achieved due to low response rate. However the trends that emerged let us make some subjective conclusions; adherence related interventions were fairly common, a dedicated MTM pharmacist may be a feasible in a community setting, most patients are unaware of what MTM is but do find it useful after the service, and challenges to implementing an MTM service from the store level.

Class of 2015 Abstract / Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

Class of 2005 Abstract / Objective: To determine the effect that a pharmacist run diabetes mellitus (DM) care clinic has on glycemic control, as measured by glycosylated hemoglobin (HbA1c) levels. The baseline comparison group is the current standard of care consisting of physician only treated DM patients. Methods: This project is a retrospective cohort analysis of clinical data obtained from patient charts, patients were matched on age. The pharmacist treated group, from a community health center clinic with a collaborative care agreement for the treatment of DM (Group 1), provided comprehensive DM treatment based upon a prearranged treatment protocol with clinic physicians. The physician treated group, is from an outpatient clinic situated at a community hospital (Group 2). The primary outcome was change in HbA1c over at least a 6 month period of time. Patients from both groups were diagnosed with type 2 diabetes mellitus, >18 years of age, and enrolled in an Arizona Health Care Cost Containment System (AHCCCS) Medicaid insurance program. Patients could be treated with oral antidiabetic medication, an insulin product, or a combination of both. Results: A total of 321 patients were included in the study, Group 1 n=161, Group 2 n=160. Ages were similar, mean age=57.7 (SD=12.2) for Group1 and mean age=57.4 (SD=12.3) for Group 2. Gender (male=33.5% and 37.5% respectively) and ethnicity were also similar (p>0.45). The average HbA1c levels at baseline and at the end of treatment were as follows; Group 1 (9.8 and 7.8), and Group 2 (8.8 and 8.9) p<0.001 for post treatment comparison. Implications: This study indicates that physician pharmacist collaborative care improves glycemic control, as shown by significantly lower HbA1c levels than the physician treated group.