• A 12-Month Comparison of Medication Adherence, Combination Therapies, Psychiatric Hospitalization Rates and Cost of Care in Patients with Schizophrenia on Clozapine versus Quetiapine in an Outpatient Mental Health Treatment Facility

      Fankhauser, Martha; Bahraini, Zhinus; Baqseh, Aftehar; Quah, Bee-Chin; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: This 12-month retrospective, naturalistic study determined medication adherence, psychiatric hospitalizations, cost of services, cost of prescriptions, and rates of polypharmacy (less than 4 versus greater than or equal to 4 concomitant psychotropic medications) for patients receiving clozapine versus quetiapine therapy for the treatment of schizophrenia in an outpatient mental health facility. Methods: The clozapine and quetiapine groups were compared for gender, age, medication adherence rates, hospitalizations, cost of care, polypharmacy, and types of concomitant psychotropic medications over 12-months. The polypharmacy groups for clozapine and quetiapine (e.g., greater than or equal to 4 psychotropic medications versus less than 4 psychotropic medications) were compared for medication adherence. Results: A total of 71 patients met the entry criteria (44 = clozapine and 27 = quetiapine). The two groups were similar for age, gender, court order, average daily dose, and hospitalization rates. The clozapine group had a higher medication adherence rate of 0.901 (e.g., 329 days supply) compared to the quetiapine group’s adherence rate of 0.723 (e.g., 264 days supply) (p=0.007). The clozapine group had higher costs for medication, labs, and other services compared to the quetiapine group, as well as total costs of services (p=0.004). The clozapine group was on fewer concomitant psychotropic medications compared to the quetiapine group based on the rates of polypharmacy. Conclusions: Patient on clozapine therapy had improved medication adherence and lower rates of polypharmacy, but higher costs of care compared to quetiapine. The frequent monitoring required with clozapine may result in medication adherence that results in improved efficacy, less polypharmacy, and lower hospitalization rates. Further studies in larger populations are needed to compare different frequency rates of monitoring patients on outcome measures over a longer period of treatment.
    • Adherence to Mood Stabilizers Using a Pharmacy Prescription Database Analysis: Assessment of the Relationship of Non-Adherence to Hospitalization Rates, Cost of Care, and Gender for Patients with Bipolar Type I Disorder

      Fankhauser, Martha; Slack, Marion; Kale, Andrea; Kuchanskaya, Yuliya; College of Pharmacy, The University of Arizona (The University of Arizona., 2006)
      Objectives: This study utilized a prescription claims database to retrospectively assess the relationship between adherence rates with a mood stabilizer in bipolar type I patients for: gender, age, psychiatric hospitalization rates, cost of services, and concomitant psychotropic medications. Methods: Adult patients with bipolar type I disorder (N=149; F=92 and M=57) who received at least two prescriptions of a mood stabilizer (i.e., carbamazepine, lamotrigine, lithium, oxcarbazepine, and valproic acid) during a 3-month intake period were included. Adherence to the mood stabilizer was retrospectively analyzed using high: >75% (> 274 days) vs. low: < 75% (< 274 days) supply of a mood stabilizer during 12-months. Results: Only 35.6% of the patients (N=53) met the criteria for > 75% adherence and 11.4% (N=17) met the criteria for > 90% adherence. There was a trend toward women having more days supply of a mood stabilizer compared to men (p=0.08) and older patients having a higher adherence rate with a mood stabilizer (p=0.06). The high adherence group had greater prescription costs (p<0.001) and total cost per year (R2=0.34, p=0.064) and more concomitant medications (p=0.04) than the low adherence group. Overall, there were no significant differences between the high and low adherence groups for mean hospital days, inpatient costs, and total cost of care. Among those patients that were hospitalized there was a negative correlation between adherence and inpatient cost (R2=0.49, p=0.024). Conclusions: Our findings suggest that patients with bipolar type I disorder demonstrate poor medication adherence with a mood stabilizer and that adherence rates based on a prescription claims database using two adherence categories may not be a predictive factor for psychiatric hospitalizations or cost of care.
    • Comparison of Prescribing Patterns for Typical and Atypical Antipsychotics in Patients with Schizophrenia Before and After the Publication of the Phase I "CATIE" Trial

      Fankhauser, Martha; Slack, Marion; Varga, Ross; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: This retrospective analysis compared the prescribing rates of typical versus atypical oral antipsychotics in the treatment of schizophrenia for 6 months before versus 6 months after the publication of the Phase 1 CATIE trial on September 22, 2005. Methods: Prescription and membership databases from COPE Behavioral Services in Tucson, AZ were utilized for determining prescribing rates of typical and atypical antipsychotics for pre- versus post-publication of the CATIE trial. Comparisons were made for gender, court order treatment, hospitalizations and length of stay, costs of services (case management, inpatient, lab, and other services), total number of prescriptions and number of tablets/capsules of typical and atypical antipsychotics, and cost of antipsychotic prescriptions. Results: There was no significant difference in prescribing rates for oral atypical and typical antipsychotics, cost of services, or hospitalization rates in the pre-publication (N=316) versus post-publication (N=336) groups. Atypical antipsychotics accounted for approximately 77% of antipsychotic prescriptions and for 98% of the total costs for antipsychotic therapy in the two time periods. During the 12-month study, the amount paid for atypical antipsychotic prescriptions was $ 1,026,004 versus $ 22,671 for typical antipsychotics. Conclusions: Prescribing patterns of oral typical and atypical antipsychotics for the treatment of schizophrenia did not change during the first six months after the publication of the phase I CATIE trail in this outpatient population. Atypical antipsychotics accounted for the majority of prescriptions and for the highest cost compared to other services provided despite similar efficacy to typical antipsychotics in the treatment of schizophrenia.
    • Evaluation of the Didactic Pain Management Curriculum at the University of Arizona College of Pharmacy

      Fankhauser, Martha; Draugalis, JoLaine; Goeller, Adrienne; Patel, Sushma; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: This study evaluated the didactic pain management curriculum from 2003 to 2006 at the University of Arizona College of Pharmacy in comparison to a compilation of current published standards. Methods: The study design was a utilization-focused evaluation conducted by two doctor of pharmacy candidates. The eleven domains of cognitive and affective abilities used for analysis were compiled from the International Association for the Study of Pain (IASP) guidelines and from published expert-panel competencies in the American Journal of Pain Management (AJPM). These documents were chosen for comparison because they were created with the purpose of developing competent and proficient pharmacy clinicians. Results: The analysis revealed that the University of Arizona College of Pharmacy was unsuccessful in meeting the recommended standards for pain management competencies. Instruction in pain management was poorly integrated, incomplete, and sporadic throughout the coursework. Conclusions: Pain management was insufficiently addressed in coursework at the University of Arizona. Separating pain from other topics, integrating pain entirely into the therapeutics course, creating a course devoted to pain management, and/or fulfilling standards through a required clerkship may improve the current curriculum. The results of the assessment will be used to provide recommendations to improve the curriculum concerning pain management.
    • Evaluation of the University of Arizona College of Pharmacy’s Curriculum and Pharmacy Students’ Knowledge and Abilities to Counsel Women about the Use of Over-the-Counter Products and Prescription Medications During Pregnancy and Breastfeeding

      Fankhauser, Martha; Quinn, Dee; Acknowledgement: Slack, Marion; Acknowledgement: Bradford, Dominique; Grimm, Rebecca; Knickerbocker-Manns, Ashley; Saldamando, Diana; College of Pharmacy, The University of Arizona (The University of Arizona., 2009)
      OBJECTIVES: The objectives of this study were 1) to review the University of Arizona College of Pharmacy’s curriculum to assess if courses cover pertinent topics in the use of prescription and over-the-counter (OTC) medications by pregnant and lactating women based on The American Association of Colleges of Pharmacy (AACP) Gender and Sex-Related Health Care Pharmacy Curriculum Guide and 2) to assess pharmacy students’ knowledge and abilities to counsel women during pregnancy and breastfeeding. METHODS: The curriculum review was a retrospective, descriptive analysis to assess how well the required curriculum addressed eight pertinent topics in the use of prescription and OTC medications by pregnant and lactating women. The self-assessment questionnaire was a cross-sectional, descriptive analysis that measured student pharmacists’ comfort level with counseling pregnant and lactating women, their perception of how well pharmacy school has prepared them for this role, and their familiarity with and use of available resources. RESULTS: The College of Pharmacy was not in compliance with AACP’s Pharmacy Curriculum Guide. This was reinforced by the questionnaire, which showed that the majority of students, regardless of year in school, did not feel they had been adequately prepared to counsel or to make recommendations to this population. CONCLUSIONS: It is recommended that the curriculum be amended by adding a lecture on teratogenicity. A list of gender and sex- related topics should be provided as well as a handout with available resources. In addition, case studies in each course should be revised to include critical decision-making, recommendations, and counseling if the patient were pregnant or breastfeeding.
    • Positive Drug Screens for Methamphetamine and/or Cocaine Versus Other Substances of Abuse in Patients with Serious Mental Illnesses: Comparison of Polysubstance Abuse, Psychiatric Hospitalizations, Prescribed Psychotropic Medications, and Cost of Services

      Fankhauser, Martha; Slack, Marion; Brown, Jessica; Whittington, Lisa M.; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: To identify differences between patients diagnosed with a serious mental illness who test positive for cocaine and/or methamphetamine compared to patients who test positive or other abused substances. Methods: This retrospective study of clinical data obtained through a community mental health agency that provides outpatient services for patients with a serious mental illness. The study population was divided into two subgroups: positive cocaine and/or methamphetamine drug screen versus other positive drug screens and were compared over a 12- month period for the frequency and types of positive drug screens and blood alcohol levels, days of court-ordered treatment, the number of psychiatric hospitalizations and length of stay, primary psychiatric diagnosis, and the cost of care for services provided. Results: More females were in the “cocaine/methamphetamine” group versus more males in the “other substances of abuse” group, (p < 0.01). A higher proportion of patients diagnosed with psychotic disorders tested positive for “other substances” than for “cocaine and methamphetamine” (p < 0.01) and the “cocaine/methamphetamine” group had significantly more mood and anxiety disorders than the other group (p < 0.05). The frequency of patients testing positive for marijuana, methadone, and other opiates was higher in the “other substance abuse” group (p < 0.001). Patients in the “cocaine/methamphetamine” group had higher rates of polysubstance abuse (p < 0.001). The most commonly abused substance was cocaine (53.8%). Conclusions: Regular drug screening for substances of abuse and utilization of drug treatment programs should be recommended for SMI patients to improve their care and treatment outcomes.
    • Psychotropic Polypharmacy in Outpatients with Schizophrenia: Comparison of Oral Psychotropic Adherence Rates, Duplication of Therapy, Psychiatric Hospitalizations, Cost of Services, and Concomitant Medications

      Fankhauser, Martha; Confer, Jennifer; Laird, Deborah; College of Pharmacy, The University of Arizona (The University of Arizona., 2007)
      Objectives: A prescription claims database from COPE Behavioral Services in Tucson, Arizona was used to retrospectively assess the differences between patients receiving <4 and those receiving > 4 psychotropic medications over a 12-month period in adult patients with schizophrenia. Methods: Medication groups (i.e., < 4 versus > 4 concomitant psychotropic agents) were compared for differences in gender, age, duplication of antipsychotic therapy, adherence rates, court order treatment status, psychiatric hospitalization rates and length of stay, cost of services provided, and concomitant psychotropic medications. Results: A total of 506 adult patients with schizophrenia (F=214 and M=292) met the inclusion criteria for receiving psychotropic medications during the 12-month study. Of those, 388 patients (76.7%) were found to have an average of < 4 medications, while 118 patients (23.3%) were found to have > 4 medications. Duplication of antipsychotic therapy was more common in the > 4 group (29.7%) compared to the < 4 group (3.1%), p < 0.001. Psychotropic adherence rates were significantly higher in the > 4 group based on month’s supply of prescriptions. Demographic differences between groups included: increased age, more women, fewer court order status, and higher cost of care in the > 4 compared to the < 4 medication group. No differences in hospitalizations, length of stay, and hospital costs were found between groups. Conclusions: Our findings suggest that patients with schizophrenia with increased rates of polypharmacy have higher adherence rates, more duplication of antipsychotics, and a higher cost of care (i.e., case management, laboratory, other services, total prescription costs) compared to patients receiving < 4 psychotropic medications.
    • Self-­‐Assessment of Drug Information Skills by Third and Fourth Year Pharmacy Students

      Fankhauser, Martha; Armstrong, Edward; Apgar, David; Darbandi, David; Demelio, Kimberly; College of Pharmacy, The University of Arizona (The University of Arizona., 2010)
      OBJECTIVES: To determine and compare the ability and confidence of pharmacy students’ drug information skills at the end of their third and fourth years of pharmacy school. METHODS: This study used a self-­‐assessment questionnaire that was distributed to third and fourth year doctor of pharmacy candidates at the end of the academic year. The questionnaire consisted of 22 items using a 5-­‐point scale that ranged from excellent (5) to poor (1) and 5 demographic questions. The topics included five categories: communication issues, resource use, critical evaluation, questions and answers, and miscellaneous items. RESULTS: Seventy-­‐one of 86 (82.6%) third year students and 51 of 79 (64.6%) fourth year students participated in the study. Fourth year students were found to be more confident than third year students in their abilities to provide drug information responses in 21 of 22 questions and in all 5 category topics (p < 0.001 for each comparison). Compared to women, men were more comfortable in speaking with health care professionals about drug information requests (p = 0.047), and were more confident in their ability to use International Pharmaceutical Abstracts (p = 0.035), to prepare an appropriate recommendation when conflicting information was found in the literature (p = 0.040), and in evaluating meta-­‐analysis literature (p = 0.045). CONCLUSIONS: Additional drug information requirements and experiences during the fourth year clinical rotations were associated with higher confidence in the self-­‐perception of drug information skills compared to third year pharmacy students who only had didactic courses in drug information. More studies need to be completed that compare different types of drug information rotations and requirements.