Objectives: 1) To determine 2010 pharmacy-related ambulatory care sensitive condition (ACSC) hospital discharges by Tennessee (TN) county; 2) To explore pharmacy-related ACSC hospital discharges across county characteristics for Tennessee counties, including community pharmacies per county, age, and county rurality; 3) To explore pharmacy-related ACSC hospital discharges across age for northeastern Tennessee counties. Methods: Data were obtained from the TN Department of Health Statistics (hospital discharge data), TN Board of Pharmacy (licensed community pharmacies), the United States (US) Census Bureau (county-level populations), the Office of Rural Health Policy (rural designations), and the US Health Resources and Services Administration (health professional shortage area designations). ACSC discharges were determined using the Agency for Healthcare Research & Quality's (AHRQ's) Prevention Quality Indictors (PQIs) for asthma, bacterial pneumonia, congestive heart failure, chronic obstructive pulmonary disease, hypertension, uncontrolled diabetes, and short-term and long-term diabetes complications. County-level analyses were population adjusted and analyzed across age. Analyses were conducted using SPSS and ArcGIS software. Results: In 2010, 79,683 hospital discharges were noted for pharmacy-related ACSCs, 55% of which were for residents 65 and over. For northeast Tennessee counties, 8,538 were documented accounting for 11% of Tennessee pharmacy-related ACSCs discharges. Bacterial pneumonia, heart failure, and COPD accounted for nearly 65% of discharges in northeastern Tennessee counties. The number of community pharmacies per Tennessee county was statistically significantly negatively correlated with county-level bacterial pneumonia (r=-0.339; p=0.001), CHF (r=-0.215; p=0.036), and COPD (r=-0.403; p<0.001) hospital discharges. Implications/Conclusions: Community pharmacies have the potential to positively impact the health needs of Tennesseans by targeting services (e.g., MTM, immunizations, adherence assistance) based on ambulatory care sensitive conditions. Future research is warranted to quantify current services and determine the capacity to provide such services.

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Objectives: To examine the extent to which pharmacy students’ attitudes, subjective norm beliefs, and perceived behavioral control beliefs explain gray dispensing decisions, using the theory of planned behavior (TPB) as a framework. Method: Third professional year pharmacy students (n=159) from two academic cohorts were provided three written case scenarios: (1) a dentist prescribing outside of his scope of practice; (2) a physician prescribing for a family member; and (3) a patient who was out of refills on insulin. A brief questionnaire assessed TPB constructs, whether or not the student would dispense the medication, and the number of times the student would dispense in 10 similar situations. Composite scores were calculated for TPB constructs after analyzing internal consistency reliability. Linear regression techniques were used to analyze the influence of the constructs on mean intent to dispense in similar scenarios. Results: The percent of students who indicated they would dispense in each scenario was 68% in scenario 1, 74% in scenario 2, and 81% in scenario 3. For all case scenarios, mean intent to dispense in similar scenarios was explained by attitude scores (p≤0.006). For the insulin refill and family prescribing cases, mean intent to dispense was also explained by subjective norm beliefs (pImplications: Student attitudes consistently predicted intention to dispense across the gray scenarios. These findings can be used to develop and target upstream TPB construct interventions in pharmacy education that influence students’ downstream dispensing decisions. Additional research is warranted to determine if TBP constructs similarly explain the dispensing behaviors of practicing pharmacists.

Drug poisoning due to overdose is a major health problem in Tennessee. In TN there has been an increase of 210% in accidental overdose deaths since 1999 to 2010. About 80% of drug poisonings in Tennessee were either accidental or self-inflicted. Also as indicated by the CDC in 2010 enough drugs were prescribed to medicate every American adult around-the-clock for one month and the vast amount of drugs increases the risk of misuse. Drug Take Back Events are a useful measure for reducing the number of prescription medications kept in the households. However, the extent to which these events have affected in the reduction of drug poisoning is not well known. The objective of this study was to investigate the relation between the total number of drugs collected at Take Back Events and emergency department admissions due to overdose in three Counties in Northeast TN. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations for controlled substances (CS) were analyzed for Washington, Carter and Sullivan County, Tennessee, from 2009 to 2012. Data were obtained from Tennessee Department of Health on number of emergency department (ED) admissions due to overdose based on International Classification of Diseases (ICD)-9 codes occurred between 2009 and 2012 in the above-mentioned counties. Linear forecast trend-line method was used to evaluate associations between the amount of controlled substances collected via donation boxes and number of ED visits occurred during 2009-12. Furthermore Pearson’s correlation analyses were conducted to investigate relationship between drop box donations and ED admissions due to overdose. From 2009 – 2012 the ED visits shows a significant decrease as the amount of drugs collected increases for Washington and Carter County. Also a negative correlation is seen between the ED visit and drugs collection for Washington and Carter County with R2 values of -0.96 and -0.90 respectively. However the same is not true for Sullivan County as the trend was not inversely proportional and also the correlation between ED visits and gathered drugs is low with R2 value of -0.562. These results quantify the potential impact of drug take back events on reduction in drug poisoning due to overdose in Northeast Tennessee. Further study is required to examine the effect of the events on the epidemic of prescription drug abuse and misuse.

The US Food and Drug Administration (FDA) is encouraging the innovation of long-acting opioid formulations that are manipulation-resistant. The purpose of this commentary is to assess the benefits and limitations of abuse-deterrent opioid formulations (ADFs) and discuss their role in mitigating the current opioid epidemic. ADFs have been created with chemical properties that make it difficult for people who non-medically use prescription drugs to crush and dissolve opioid tablets, as well as by combining opioids with antagonists such as naloxone or naltrexone, which are released only when the dosage form has been manipulated or the drug is taken by a non-intended route. Despite these and other technologies, consensus regarding the effectiveness of these formulations in preventing non-medical use is lacking given the difficulty in obtaining post-marketing data. Researchers also question if the creation of abuse-deterrent drugs will have a positive effect on those struggling with a severe opioid-use disorder, fearing that current opioid users will simply find a new – perhaps more dangerous – drug of choice. Abuse-deterrent opioids are still opioids, and although they may make manipulation more difficult than non-ADF formulations, they are not “abuse proof.” The introduction of ADFs could provide a false sense of security among prescribers and dispensers, and we fear that ADFs may have a minimal impact on non-medical use of prescription opioids. Further epidemiological studies will be required to determine the large-scale impact of abuse-deterrent opioids in preventing opioid use disorder and its downstream consequences.

The next presentation will examine common gray areas of community pharmacy practice. For example: under what circumstances do pharmacists fill early, transferred controlled substance prescriptions for out-of-town patients; when do pharmacists sell syringes to patients without proof of medical need; and how do pharmacists determine that a buprenorphine prescriber is acting in a patient's best interest? These and other ethical or legal dilemmas challenge pharmacists as they try to balance identifying and preventing potential drug abuse and diversion with providing evidence-based, quality patient care. Based on data from pharmacists and pharmacy students, as well as established theory, presenters will describe typical approaches to decision-making. Multiple pharmacy cases will be discussed. Participants will learn how to integrate best-practice patient care systematically into common practice scenarios.

This webinar will describe East Tennessee State University’s efforts to curb the opioid epidemic along the continuum of addiction. ETSU’s Academic Health Science Center has engaged multiple constituents to conduct federally funded research, community based practice and more importantly, to foster cross-sector engagement and education. The team hosts monthly meetings to facilitate partnerships across sectors with multiple aims. These aims include regional health improvement, research capacity development and community outreach. By the end of this webinar, participants will be able to: Describe multiple evidence-based approaches for the prevention and treatment of opioid use disorder. Describe techniques for engagement in community and cross-sector collaboration to address the opioid use disorder crisis.

A lack of available data exists regarding environmental factors related to prescription drug abuse (PDA), which could explain the ineffectiveness of efforts to reduce PDA in Florida. Prescription drug abuse among adults older than age 18 varies with the level of education achieved, and these metrics potentially reflect socioeconomic differences. The purpose of this quantitative study was to examine the connections between contextual aspects of prescription opioid abuse among Florida's middle and high school students to understand youth PDA in relation to their environments. This study consisted of a secondary analysis of existing PDA data (dependent variable) in relation to a number of independent variables, including the incidence of female-headed households, the nature of residential environment, adherence to religious precepts, and students' ability to achieve educational goals. Incidence of female-headed households, the nature of residential environment, and adherence to religious precepts were not found to predict youth PDA. The only finding of significance was that PDA predicted lowered students' ability to achieve educational goals (p = .015). Data collected from this study might be used by school counselors and administrators when developing drug abuse prevention, intervention, and educational programs, thereby leading to positive social change in helping to reduce PDA among youth.

Ce travail présente le développement d’une nouvelle approche pharmacoépidémiologique, reposant sur les bases de données de l'assurance maladie, permettant de caractériser et d’estimer le détournement d’usage de médicaments psychoactifs. Cette approche utilisant la méthode de classification, regroupe, a posteriori, les sujets en différents sous-groupes, menant à l’identification, la caractérisation et la quantification de différents profils de comportement dont le comportement déviant. Nous avons appliqué cette méthode sur plusieurs médicaments. Pour chaque médicament, nous avons inclus l'ensemble des sujets affiliés au régime général des régions PACA et Corse ayant eu un remboursement. Leurs délivrances ont été suivies sur 9 mois. Après une analyse descriptive, une méthode de classification est appliquée, suivie d’une analyse des différents sous-groupes.Un premier travail a permis de confirmer l'importance du détournement d'usage d'une molécule émergente, le clonazépam (publication n°1). Ensuite nous avons adapté notre méthode afin de pouvoir suivre l'évolution sur plusieurs années de ce détournement (publication n°2). Nous avons appliqué cette méthode pour souligner l’existence, sur plusieurs années, du détournement d'usage du méthylphénidate (publication n°3). Notre équipe avait également développé une autre méthode pour estimer la polyprescription (publication n°4). Enfin, nous avons appliqué de façon conjointe ces deux méthodes (publication n°5). La méthode de classification est de plus en plus utilisée afin de surveiller l'évolution du détournement d'usage de médicaments et commencent à être intégrés au système français de surveillance de l’abus de médicament.aux cotés des autres outils pharmacoépidémiologiques plus traditionnels (OSIAP, OPPIDUM, OPEMA, ASOS, DRAMES). / This work presents the development of a new pharmacoepidemiologic method. This methodallows to estimate abuse of psychoactive prescription drugs in real life using prescriptiondatabase. The method is based on a cluster analysis which is a statistical method used todetermine, a posteriori, different subgroups of subjects. According the subgroups’characteristics, we can determine and estimate different behaviours whose subjects with adeviant behaviour. It assesses the rate of subjects with a deviant behaviour among all thesubjects that obtain the drug from a pharmacy.We used this method on several prescription drugs. For each prescription drug, we includedall individuals, affiliated to the French health reimbursement system of two southern Franceareas (Provence-Alpes-Côte-d’Azur and Corsica), who have had a prescription drugreimbursed during the first weeks of the year. Their deliveries have been monitored over a 9month-period. After a descriptive analysis, a clustering method has been used. The fourquantitative variables used to establish profiles of consumers were : number of differentprescribers, number of different pharmacies, number of dispensings and quantity dispensed(DDD). Finally, the characteristics of different subgroups have been presented, especiallythose with a deviant behavior.The first study using this method allows to confirm and assess the magnitude of the abuseliability of an emerging prescription drug as clonazepam (publication n°1). Then we adapt thismethod in order to follow the abuse evolution during several years. In the second publicationon clonazepam, we identified that the proportion of deviant subjects has increased between2001 and 2006 (from 0.86% to 1.38%). We also applied this method to estimatemethylphenidate abuse during several years (from 2005 to 2008) (publication n°3).Methylphenidate abuse is already describe in other countries whereas few data are available inFrance. This study estimates the proportion of subjects with a deviant behaviour (from 0.5%9in 2005 and in 2006 to 2.0% in 2007 and 1.2% in 2008) and assesses its evolution since theapplication of a specific regulation.Our research team has also developed an other method using prescription database : thedoctor shopping indicator which measures the quantity obtained by doctor shopping amongthe overall quantity reimbursed (publication n°4). The objective of the last publication is toanalyze and compare results from those two methods applied to High Dosage Buprenorphine,a product well-known to be diverted in France.Actually, clustering method is more and more used on prescription drugs in order to assesstheir abuse. The results obtained by this method begin to be included in the other postmarketing surveillance of CNS drugs (OSIAP, OPPIDUM, OPEAM, ASOS, DRAMES)which are used by French public health authorities.

Previous studies have shown that Medicare Part D beneficiaries tend not to switch plans even though they are encouraged to reevaluate their current plans and switch plans if needed every year. Little is known about why this "plan stickiness" occurs, so there is a critical need to better understand this non-switching behavior. This dissertation project aimed to describe how Part D beneficiaries processed information and how they perceived the plan switching process. It also aimed to describe how switchers and non-switchers were different and to test a model of Part D plan information processing that adapted from Motivation, Opportunity, and Ability (MOA) model. To achieve these objectives, this study had a cross-sectional descriptive design and used a mixed- methods approach consisting of focus groups, interviews, and mailed survey. The qualitative study sample was recruited from two cities in Iowa and transcripts of audio-recorded discussions were analyzed. The population studied in the quantitative phase was voter registered Iowa Part D beneficiaries who were older than 65 and did not receive Low Income Subsidies (LIS). Stratified random sampling was used to identify survey subjects. An eight page survey assessing factors related to Part D plan decisions was developed and mailed to 2,250 subjects, with reminder postcards as well as phone calls used to increase response rate. Finally, confirmatory factor analysis and structural equation modeling (SEM) were used to test a model of Part D plan information processing. A total of 16 participants from three focus groups and three interviews were included in the qualitative analysis. The results indicated that Part D beneficiaries processed different amounts of information even though they made the same decision (i.e. non-switching); whether to receive help from others in reviewing coverage options emerged as an important theme in the plan switching decision. A usable response rate of 22.5 percent was obtained. Of this sample, 264 respondents were non-LIS Part D beneficiaries and were used for further analysis. About one fifth of the sample switched plan between 2012 and 2013, supporting existing literature that has reported a low plan switching rate. Switchers and non-switchers had few demographic differences, but twice as many switchers as non-switchers received help from others in reviewing coverage options. The results from the SEM analysis indicated that those who had lower risk perception about plan switching, higher motivation, and higher self-efficacy were likely to read larger amounts of plan information. They also indicted that higher perceived risk, involvement, and self-efficacy were positively associated with motivation to process plan information. The findings of this dissertation suggest that plan stickiness has two types - active (i.e. informed choice) and passive (i.e. inertia) - depending on the amount of information processed, which was determined by beneficiaries' levels of perceived risk, motivation, self-efficacy, and needs. Furthermore, findings suggest that whether to receive help in understanding plan information may play a large role in leading informed beneficiaries to act on their knowledge and switch plans. The present study is the first to integrate the concept of information processing to understand Part D beneficiaries' plan switching decisions and the first to examine psychological factors affecting beneficiaries' information processing as well as their plan switching decisions. Study findings will help policy makers developing efficient communication strategies with beneficiaries to help them to make informed choices.