A Progressive,Collaborative Process to Improve a Curriculum and Define an Assessment Program

Objective. To revise the University of Oklahoma College of Pharmacy’s professional program outcomes and create an assessment map using results from previous peer review and mapping of all professional courses and curricular streams of knowledge, skills, and attitudes (KSAs).Design. After consolidating 15 original program outcomes into 11 more precise outcome statements, defining KSAs for each, and getting faculty approval of them, the committee detailed measurable program expectations upon graduation for each outcome and created an assessment map identifying where KSAs were taught, how they were to be assessed, and the expected ability level (novice, competent, proficient) for each across the curriculum.Assessment. The committee’s work identified deficits, inconsistencies, and disproportionalities in professional program assessment. It recommended assessments to capture student achievement of each outcome, identified performance levels and criteria to measure outcomes progressively in each professional year, and outlined a process to provide students periodic reports on their progress in achieving each outcome.Conclusion. This work establishes a firm foundation for ongoing efforts to measure effectiveness of the professional program, especially in light of Accreditation Council for Pharmacy Education’s (ACPE) revised accreditation standards.     

Time preference for health gains versus health losses

The purpose of this research was to determine whether people devalue further health gains differently from future health losses. 108 subjects in various states of health were randomised to groups that rated their preference for a hypothetical health gain or loss of variable duration and delay, in the condition of arthritis. Direction and duration of the hypothetical future health change had an interactive effect on time preference (p less than 0.001). For the health gain, devaluation due to delay was consistent across durations. For the health loss, devaluation depended on duration; the long-duration loss was devalued with delay while the fleeting loss was inflated. These findings cast doubt on the assumptions of positive time preference and constant rate discounting that underlie the classical model of discounting. They provide support for a theory of intertemporal choice which posits that vivid, fleeting, future events engender 'anticipation utility' which attenuates positive time preference. Our findings suggest that standard practices for discounting future health outcomes in economic evaluations of arthritis and possibly other conditions may need to be re-examined.     

Quality of life 2

In 1990, health care expenditures in the United States reached $666.2 billion, 12.2% of the gross domestic product (GDP). It is projected for the year 2000, the USA will spend $1.6 trillion for health care which will be comparable to 16.4% of that year's GDP. As a result of the rapid increase in costs of health care and limited resources available, patients/third-party payers and the government have initiated and implemented more rigid cost control measures. Economic analyses can help ensure the efficient use of health care dollars in areas such as drug therapy. The four methodologies available are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis and cost-utility analysis. This article reviews methods and provides examples from the medical literature. These tools can assist care providers in determining which treatments are most cost-effective.     

The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores

Background

The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions.

Identifying psychological contract breaches to guide improvements in faculty recruitment, retention, and development

Objective. To identify pharmacy faculty members' perceptions of psychological contract breaches that can be used to guide improvements in faculty recruitment, retention, and development.Methods. A list of psychological contract breaches was developed using a Delphi procedure involving a panel of experts assembled through purposive sampling. The Delphi consisted of 4 rounds, the first of which elicited examples of psychological contract breaches in an open-ended format. The ensuing 3 rounds consisting of a survey and anonymous feedback on aggregated group responses.Results. Usable responses were obtained from 11 of 12 faculty members who completed the Delphi procedure. The final list of psychological contract breaches included 27 items, after modifications based on participant feedback in subsequent rounds.Conclusion. The psychological contract breach items generated in this study provide guidance for colleges and schools of pharmacy regarding important aspects of faculty recruitment, retention, and development.     

Initial treatment choice in depression: impact on medical expenditures

OBJECTIVE: The purpose of this study was to examine the economic outcomes associated with initial treatment choice following a diagnosis of depression. METHODS: Insurance claims data were used to classify patients into one of 4 treatment cohorts: no therapy, psychotherapy, drug therapy and combination therapy. Potential sample selection bias was accounted for by using a 2-stage econometric estimation procedure where initial treatment choice was estimated using a multinomial logistic regression model in the first stage, and total and mental healthcare costs were estimated in ordinary least squares regression models in the second stage. Log predicted costs from the second stage were compared to determine the relative costs associated with each cohort. RESULTS: Significant differences (p < 0.008) in total costs were found between the combination therapy (log predicted cost = 9.526) and psychotherapy cohorts (log predicted cost = 8.120) in the analysis that included all observations (n = 9110). In the analysis that included patients who initiated therapy with a non-mental health provider (n = 2673), the drug therapy cohort (log predicted cost = 8.238) was found to be significantly more costly as compared to the no therapy cohort (log predicted cost = 7.788). CONCLUSIONS: These results indicate that after controlling for both observed and unobserved factors, total healthcare costs may be higher in patients who initiate therapy with drug therapy and combination therapy as opposed to no therapy or psychotherapy. In addition, the finding that patients initially receiving psychotherapy alone tend to have higher mental healthcare costs but lower total healthcare costs than other patients may indicate that psychotherapy has an impact on comorbid illness and may subsequently reduce total healthcare costs.