This study used the Andersen Model for Health Services Utilization to examine a pharmacist-provided telephone MTM program among Medicare Part D beneficiaries. Predisposing (age, gender, race) and need factors (number of medications, number of chronic diseases, medication regimen complexity) were assessed. The health behavior, MTM utilization, distinguished the intervention and control groups. The health outcomes were change in number of medication-related problems, change in medication adherence [using the medication possession ratio (MPR)], and change in total drug costs. Medication knowledge, medication adherence (using the Morisky Scale), and patient satisfaction were also measured in the intervention group. The intervention and control groups were not significantly different in age (71.2 ± 7.5 vs. 73.9 ± 8.0 years), number of medications (13.0 ± 3.2 vs. 13.2 ± 3.4), number of chronic diseases (6.5 ± 2.3 vs. 7.0 ± 2.1), and medication regimen complexity [21.5 (range 8 – 43) vs. 22.8 (range 9 – 42.5)], respectively. For the subset of problems that was evaluated in the intervention and control groups, 4.8 (± 2.7) and 9.2 (± 2.9) problems were identified at baseline and 2.7 (± 2.3) and 8.6 (± 2.9) problems remained at the 3-month follow-up, respectively. Cost-related and preventative care needs and drug-drug interactions were the three most common problems identified. Multivariate regression analysis revealed that the intervention group had significantly more problems resolved (p < 0.0001) when compared to the control group, while controlling for predisposing and need factors. Significantly fewer problems were resolved (p = 0.01) as number of diseases increased and significantly more problems were resolved (p = 0.01) as medication regimen complexity increased. There were no significant predictors of change in MPR or total drug costs from baseline to the 3-month follow-up. Medication knowledge and medication adherence measured by the Morisky scale did not change significantly from baseline to the 2-week follow-up. However, patients were very satisfied with the service. A pharmacist-provided telephone MTM program was an effective method for identifying and resolving medication and health-related problems. A longer follow-up period may be necessary to detect the impact of pharmacist provision of MTM on adherence, total drug costs, and knowledge. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle. / School of Nursing

Previous studies reported that noncompliance to diabetes treatment may result in a series of health complications. To further understand patients’ noncompliance to meal plans, a study on meal planning strategy was developed. Through a survey Certified Diabetes Educators determined which meal planning strategies were the most effective in encouraging patients’ compliance to meal plan according to age groups (18 and under, 19 to 49, 50 to 70, and 71 and above) and recency of diagnosis (newly- and non-newly diagnosed) with Type 2 diabetes. Results identified that nutrition labels had the greatest mean rating for effectiveness in age groups 18 and under, 19 to 49, and 50 to 70; and healthy food choices had the greatest mean rating for effectiveness with age group 71 and above. / Department of Family and Consumer Sciences

The relationships between post-traumatic growth (PTG), benefit finding, happiness, pessimism and antiretroviral (ART) medication adherence were examined among 10 people living with HIV or AIDS who attended HIV support groups, and were currently prescribed ART medications. Analyses indicated that none of these psychosocial factors were significantly correlated with ART adherence, that the relationships continued to be non-significant after pessimism was partialled out of the analysis, and that participants who reported achieving optimal ART adherence did not significantly differ from participants who reported taking less than optimal ART adherence in regards to PTG, benefit finding, subjective happiness, or pessimism. The results suggest that interventions designed to change these psychosocial factors may not be effective means of improving ART adherence. / Department of Psychological Science

While insulin omission has been found to be a common behavior in those with type I diabetes, it has been primarily studied within the context of disordered eating behavior. Previous research supports medical providers and patients lack of comfort in discussing insulin omission. This study was designed to answer two questions. Why do young adult college students with type I diabetes omit insulin? and what factors facilitate and act as barriers to open communication regarding insulin omission in the patient-provider interaction. A total 13 (10 females, 3 males) college students completed a qualitative interview focused on insulin omission and communication of this behavior to medical providers, and 11 of the 13 completed a modified EAT-26. Using consensual qualitative research methods CQR (Hill, Thompson, & Williams, 1997), domains that emerged were reasons for insulin, predominant reason for insulin omission, motivators to give insulin as prescribed (i.e., adhere), overall communication of insulin omission to medical providers, and factors facilitating and barriers inhibiting communication regarding insulin omission to medical providers. Typical reasons for insulin omission included forgetting or delaying and forgetting, worrying about hypoglycemia and its social implications, being in situations where limited access to food/medical supplies, planning to be physically active, or being unsure of carbohydrate count in food. Insulin omission as a weight loss behavior was not reported by any of the participants during the interviews and all denied using insulin as a way to control their weight or shape on the EAT-26. Clinical implications and future research directions are discussed. / Department of Counseling Psychology and Guidance Services

HIV/AIDS is the world's most urgent public health challenge. It is the leading cause of death for young adults worldwide. There is as yet no vaccine and no cure. The high unemployment rate and poverty experienced in South Africa contribute to the high HIV/AIDS infection levels experienced in the country. With the vast majority of HIV/AIDS cases and the growth in the number of people infected who will look towards publicly funded hospitals for medical care, the financial strain on government hospitals and pharmacies will be severe, not only as a result of the sheer number of people seeking healthcare, but also because healthcare for HIV/AIDS patients is more expensive than for most other conditions. Antiretroviral treatment is the main type of treatment for HIV/AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a patient's life. Antiretroviral treatment has complex and rigorous dosing requirements. The aim of antiretroviral treatment is to keep the amount of HIV/AIDS in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV/AIDS might have caused already. Medication compliance means taking the medications exactly as prescribed by the doctor for the amount of time intended. Medication noncompliance, on the other hand, means taking medications in any way other than what the doctor prescribed. While noncompliance may not seem like a big deal, it can have serious consequences. The challenge of optimizing adherence to anti-retroviral treatment remains paramount in the treatment of HIV/AIDS. The purpose of this study is to establish the cost of a patient defaulting anti-retroviral treatment per month, and to determine the financial and economic impact that defaulting patients has on General de la Rey and Thusong Hospital Complex Pharmacies. The study further aims to prove that the risk of patient defaulting is a barrier to achieve organisational excellence through healthcare delivery. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.

HIV/AIDS is the world's most urgent public health challenge. It is the leading cause of death for young adults worldwide. There is as yet no vaccine and no cure. The high unemployment rate and poverty experienced in South Africa contribute to the high HIV/AIDS infection levels experienced in the country. With the vast majority of HIV/AIDS cases and the growth in the number of people infected who will look towards publicly funded hospitals for medical care, the financial strain on government hospitals and pharmacies will be severe, not only as a result of the sheer number of people seeking healthcare, but also because healthcare for HIV/AIDS patients is more expensive than for most other conditions. Antiretroviral treatment is the main type of treatment for HIV/AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a patient's life. Antiretroviral treatment has complex and rigorous dosing requirements. The aim of antiretroviral treatment is to keep the amount of HIV/AIDS in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV/AIDS might have caused already. Medication compliance means taking the medications exactly as prescribed by the doctor for the amount of time intended. Medication noncompliance, on the other hand, means taking medications in any way other than what the doctor prescribed. While noncompliance may not seem like a big deal, it can have serious consequences. The challenge of optimizing adherence to anti-retroviral treatment remains paramount in the treatment of HIV/AIDS. The purpose of this study is to establish the cost of a patient defaulting anti-retroviral treatment per month, and to determine the financial and economic impact that defaulting patients has on General de la Rey and Thusong Hospital Complex Pharmacies. The study further aims to prove that the risk of patient defaulting is a barrier to achieve organisational excellence through healthcare delivery. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.

Thesis (D.P.H.)--University of Hawaii at Manoa, 1996. / Includes bibliographical references (leaves 83-108). / Microfiche. / vii, 108 leaves, bound 29 cm