Doctor of Philosophy, The Ohio State University, 2008, Pharmacy

Pharmaceutical products are distributed through several distribution channels such as retail, hospital, and mail order. Cost containment is the major impetus driving the development of mail order pharmacy. However, currently available empirical evidence that does not support the substitution of community pharmacy by mail order services to reduce overall drug expenditures.The objective of this study was to compare drug utilization and pharmaceutical expenditures by simulating the effects of community pharmacy on drug utilization for a retiree patient population using mail order pharmacy. The data used for the analysis were pharmacy claims data for the period January 2000-September 2005. Drug claims for each patient were aggregated into courses of drug therapy (CDTs) representing unique patient IDs and unique drug products. Utilization differences between community and mail-order pharmacy were assumed to occur only at the last claim for each CDT. The simulation model employed to estimate the difference in drug utilization using mail-order pharmacy claims data assumed that discontinuation in community pharmacy would follow a random pattern. A comparison basket of products with at least one claim in both community and mail-order pharmacy during each year from 2000-2005 were selected. Unit costs and expenditures for the medications in the basket were compared across community and mail-order pharmacy. Seventy two and a half percent of the CDTs dispensed were intended for maintenance therapy and maintenance therapy was more concentrated in mail-order pharmacy as compared to community pharmacy. The use of mail-order pharmacy services resulted in an increase in drug utilization of 2.96% over community pharmacy and a reduction in pharmaceutical expenditures by 10.0-13.0% from 2000-2005. The unit total gross costs in community pharmacy were higher for about half of all products in the comparison basket of products. The differences in pharmaceutical expenditures between com (open full item for complete abstract)

Committee: Enrique Seoane PhD (Advisor); Sheryl Szeinbach PhD, RPh (Advisor); Judith Schwartzbaum PhD (Committee Member); Rosa Rodriguez-Monguio PhD (Committee Member) Subjects: Pharmaceuticals

Doctor of Philosophy, The Ohio State University, 2009, Pharmacy

The pharmaceutical industry serves societal needs by bringing innovative products and therapies to market. However, innovation does not guarantee market longevity. Consequently, some products are evaluated and considered for market discontinuation. Safety, efficacy, and financial concerns are important considerations when evaluating the reasons for market discontinuation of drugs. In this study, market discontinuation of new molecular entities (NMEs) approved by the FDA from 1980 to 2008 were analyzed. The independent variables considered for the analysis were drug characteristics (route of administration, therapeutic class), sponsor characteristics (sponsor country, sponsor with single NME during study period), drug policy (orphan drug status, accelerated review, priority review and Prescription Drug User Fee Act (PDUFA) enactment). Data were derived from the FDA, Micromedex, Medline, Lexis-Nexis and Medicaid Drug Utilization Data. A drug was considered discontinued if it was deleted from the FDA's Orange book. Withdrawals of approval were also included in the study. Descriptive statistics, chi-square tests, logistic regression and survival analysis were performed for the study. A total of 703 NMEs were approved during the study period. In December 31, 2008, 71.8% NMEs remained in the market; 14.4% were discontinued; 5.4% NMEs had the brand discontinued, but the generic was available; 7.0% had changes in route, dosage form or strength; 0.7% were never marketed and 0.9% were over-the-counter drugs. Safety was the primary reason for withdrawal of 29 (27.4%) NMEs; 4 (3.8%) NMEs had Federal Register determination for not being discontinued for safety or efficacy reasons; 5 NMEs were never marketed (4.7%) and 68 (64.2%) had no reasons stated by the FDA. Compared to other classes anti-infectives were more likely (p<0.05) to be discontinued. Analyses of priority review, orphan drug status, and sponsor company's country (US or non-US) with respect to market withdrawal we (open full item for complete abstract)

Committee: Sheryl Szeinbach PhD, RPh (Advisor); Enrique Seoane-Vazquez PhD (Advisor); Kurt Stevenson MD, MPH (Committee Member) Subjects: Biostatistics; Economics; Epidemiology; Finance; Health Care; Pharmaceuticals; Public Health

MS, University of Cincinnati, 2019, Pharmacy: Pharmaceutical Sciences

Objective: Diabetes is one of the most prevalent chronic diseases. This study aimed to examine geographic variation and temporal trends in the utilization of antihyperglycemic therapies among the U.S. Medicaid population compared to diabetes prevalence at state-level using Geographic Information system. Methods: A descriptive, retrospective study design was performed for 2011,2014, and 2016. Study drugs were categorized into biguanides, sulfonylureas-meglitinides, DPP-4 inhibitors, SGLT2-inhibitors, GLP-1 receptor agonists, insulins, and others. The annual number of prescriptions for antihyperglycemic therapies were extracted from the national Medicaid pharmacy database provided by the Centers for Medicare & Medicaid Services. Spatial analysis using ArcMap 10.5.1 was performed to create choropleth maps for diabetes prevalence and point maps for the total number of prescriptions for each antihyperglycemic therapy. The percent change in drug utilization during the study period was calculated per therapeutic class per state. Pearson's correlation test was also performed to evaluate the correlation between diabetes prevalence and antihyperglycemic therapies' usage at state level. Results: Utilization of most antihyperglycemic therapies were increased from 2011 to 2016. States with high utilization trends were NY, CA, PA, NJ, AZ, FL, IL, OH, MA, and TX, ranging from 1-fold to 50-fold overall. The five most prescribed antihyperglycemic therapies in 2016 were biguanides (41.95%), long and intermediate-acting insulins (18.9%), short and rapid-acting insulins (12.87%), sulfonylureas-meglitinides (11.37%), and DPP-4-inhibitors (7.87%). Rapidly increasing utilization trends were for GLP-1-receptor agonists, DPP-4-inhibitors, and SGLT2-inhibitors around all states. SGLT2-inhibitors usage in the northeastern states increased by 4 to 26-fold higher than its use in 2014. Sulfonylureas-meglitinides usage decreased in the southeast part of the US by 20%-58% in 2016. There is (open full item for complete abstract)

Committee: Jianfei (Jeff) Guo Ph.D. (Committee Chair); Diego Cuadros Ph.D. (Committee Member); Nicholas Messinger (Committee Member) Subjects: Pharmaceuticals

Psy. D., Antioch University, 2018, Antioch New England: Clinical Psychology

This study details the application of the Utilization Focused Evaluation model (Patton, 2012) to the Hillsborough County South Drug Court (HCSDC) program evaluation. The program requested an evaluation as part of the National Adult Drug Court model and expressed a desire to better understand their fidelity to the established model. Drug courts across the United States are required to base their programs on the Ten Key Components and the Best Practice Standards. I used this model to evaluate the extent to which the HCSDC team has utilized these concepts in their planning and execution of their drug court. The study begins with some background about drug court and an overview of the Key Components and Best Practice Standards. I discuss program evaluation, process evaluation, and Utilization-Focused Evaluation (UFE) and describe my evaluation tools. I describe my methods which involved direct observation of the program's activities, collaboration with the team, as well as definition of participant and non-participant characteristics. Analyses included calculating means, recording frequencies of events, and comparing participant and non-participant demographics. This evaluation procedure was also compared to the evaluation guidelines by the national drug court model. Qualitative data were derived from themes derived during HCSDC team member interviews. Results include areas of strength, such as providing a variety of treatment options for many levels of care, collaboration between staff, including the typically adversarial defense and prosecution, as well as mental health and recovery-focused training for all team members. Challenges included having a participant population that is representative of the local county prison, promptly admitting participants to the program, and ensuring cross-training for mental health professionals in legal matters.

Committee: George Tremblay PhD (Advisor); Cynthia Whitaker PsyD (Committee Member); Dion Dennis PhD (Committee Member) Subjects: Clinical Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2011, Psychology

Nonadherence to immunosuppressant medications following renal transplantation can lead to devastating health consequences. In order to minimize nonadherence-related negative health outcomes in children, this study aimed to identify the predictive power of the number of barriers to adherence outcomes as reported by both the parent and child. Additionally, this study aimed to determine the significance of the relationship between the parent and child's perspectives by examining the discrepancy between reports and its ability to predict adherence outcomes. Forty-one children and their caregivers participated, with children's ages ranging from 7 to 18 with a mean of 15. Results of the Parent Medication Barriers Scale (PMBS) and the Adolescent Medication Barriers Scale (AMBS) were used for analyses, as well as electronic monitoring data to measure adherence. The average rate of adherence from the electronic monitoring data in this sample was 79.3%. Findings indicate that number of barriers according to both parent (p=.904) and child (p = .393) reports are not predictive of adherence. Nor is the discrepancy between parent (p = .950) and child (p = .902) report predictive of adherence. Qualitative analysis of specific barriers suggests that parents and children do not consistently indicate the same barriers to adherence for the child. Although the number of barriers to adherence was not found to be predictive of oral medication adherence, additional exploration of specific barriers to adherence as indicated by both parents and children is suggested for future research.

Committee: Janet R. Schultz Ph.D., ABPP (Committee Chair); W. Michael Nelson III Ph.D., ABPP (Committee Member); Ahna L.H. Pai Ph.D. (Committee Member) Subjects: Health Care; Psychology