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PHAR 440

Pharmacy Administration

Hill Burton Act was introduced to Improve access to medical care.
Durham-Humphrey Law was introduced to Create prescription/legend drug (cannot dispense without prescriptions).
In what era was the Hill Burton Act? Era of expansion
When was high school graduation the minimum requirement for admission to pharmacy schools? 2nd Period of Professionalism - Era of Education Reform
"Diagnosis related groups" was established as a part of what era? Era of cost containment
What was the Kerr Mills Act (Medical Assistance Act)? Act introduced by Congress to include necessary nursing home and hospital care as an extension of Social Security benefits.
What are five solutions offered by Kelly to improve medication safety? (1) EMR, (2) national patient safety research center, (3) assessment of improvement, (4) hospital safety incentives, and (5) health care student loans for baby boomers.
What is the Millis Commission Report? Study of pharmacist's perception of his/her profession.
What is the Dichter Institute Study by APhA? Study of laymen's perceptions of pharmacist.
The Pharmaceutical Survey of 1946 resulted in The development of the five year model for pharmacy school.
Explain the Flexner report and its recommendations. A study on medical education. Proprietary schools should either close or be incorporated into existing universities.
What was the 1969 revision of APhA Code of Ethics? Held pharmacists responsible for the health and safety of patients.
What did the APhA Code of Ethics originally say? Pharmacist does not discuss the therapeutic effects of prescription with patient.
True or False -- Medicaid is a state run public welfare program financed through taxes and premiums. False -- no premiums
Discharge planning in a hospital is an example of Concurrent Utilization Review
What is an example of prospective utilization review? Prior Authorization
Who are the major players in improving medication safety? Hospital executives, physicians, federal government, pharmaceutical industry, and pharmacists.
What health insurances do general taxes fund? Medicare Part B & D, and Medicaid
What are 3 things that resulted from the enactment of Employee Retirement Income Security Act (ERISA)? (1) Protection for employees against misuse of pension funds, (2) Increase in the number of self insured companies, which led to (3) the increase in the premiums for small employers.
The purpose of Phase II in drug development is to Establish treatment effectiveness.
The purpose of Phase I in drug development is Establish the pharmacologic profile of a drug.
The purpose of NDA is Establish foreign market experience and testing.
The purpose of Phase III is Establish overall benefit risk relationship.
Patient's lack of understanding of treatment instructions leading up to medication non-adherence is an example of Patient related factors affecting adherence.
Expert reviews are used in what phase of the evaluation cycle? Logic models
The Medical Model of health delivery emphasizes Treatment
The Public Health model of health delivery emphasizes Prevention
In the SPO model by Doanbedian, "waiting time to see the physician" can be considered an example of Process
Patient believes that the perceived benefits outweigh the perceived barriers. Health belief model
Patient is a passive follower of the physician's orders. Biomedical theory
Patients are confident about their ability to take medications as prescribed. Bandura's self-efficacy theory
Which period of professionalism was considered as the era of "count and pour" pharmacy? Second
Interviewing people who have committed a medication error with the goal of identifying the underlying cause is an example of Critical incident technique
What are the 5 core elements of MTM services? (1) Medication therapy review, (2) Personal medication record, (3) Medication-related action plan, (4) Intervention and/or Referral, (5) Document and Follow up
According to the Zinner article the diagnostic-related group payments happened during which era? Government era
In PBMs, preferred brand name drugs on formulary will come under Tier 2
In PBMs, non-preferred brand name drugs on formulary will come under Tier 3
In PBMs, generic drugs on formulary will come under Tier 1
In the drug development process, multi-center trials is a characteristic of Phase III
The pharmacy organization mainly responsible for lobbying the government on behalf of the pharmacists is APhA
What percentage of health care costs in the US do physicians costs constitute? 20%
What percentage of health care costs in the US do hospital costs constitute? 30%
Failure mode effect of analysis in reducing medication errors is Assuming that no matter how well a process is designed, errors will occur
Developing a dosing schedule around a daily event such as breakfast to improve medication adherence is an example of Technical intervention
What are the six evidence-based safe medication practices identified by USP's Expert Committee on safe medication use? (1) Unit dose drug distribution, (2) protocols for high-risk drugs, (3) CPOE, (4) pharmacists in clinical rounds, (5) bar coding, and (6) patient medication counseling.
Which type of HMO offers the least physician risk bearing? Staff HMO
In pharmacy reimbursement, as earned discount increases, the gross margin Increases
What is the Drug Law of 1848? To stop entry of adulterated drugs from overseas
What is the Durham and Humphrey Act of 1951? Pharmacists cannot dispense without prescription.
What is the Pure Food and Drug Act of 1906? Prohibits interstate commerce in misbranded and adulterated foods, drinks and drugs.
What are the six eras in chronological order during the evolution of health care in America? (1) Charitable era, (2) Medical education era, (3) Insurance era, (4) Government era, (5) Managed care era, and (6) Consumerism era
What were the standards adopted by the Council on Medical Education? Minimal education requirements for medical school -- HS diploma, 2 years of college, and 4 years in the program, 2 years anatomy and physiology, and 2 years clinical.
What were the two major events during the insurance era? (1) American Hospital Association introduced Blue Cross and (2) Employer benefit packages to attract workers
What were the major events during the government era? (1) Wagner-Murray-Dingell Bill gave comprehensive health insurance under social security, (2) Hill Burton Act gave federal grants to hospitals to improve infrastructure, (3) Kerr-Mills Act (Medical Assistance for the aged), (4) DRGs, (5) Medicare Part D
What were the two major foci during the managed care era? (1) Reduce length of stay in hospitals, and (2) Reduce number of hospitals
What were the problems associated with managed care? Choice and access
What was the major consequence of the failure of the managed era? The concept of healthcare value (consumerism). Premiums increase.
What were the two major historical events that led to the formation of employer based health insurance? (1) President Franklin D. Roosevelt did not pursue universal health care coverage, and (2) tax subsidies.
What were the two events that led to the growth of employer based health insurance? (1) Government did not provide health insurance, and (2) Unions could negotiate health insurance as part of the contract.
What were the two recent developments that influenced the employer based health insurance? ERISA and FASB
What are the four major implications of employer based health insurance for the American public? (1) Employers can't make impression on providers to change how healthcare is delivered, (2) Coalition reform weakness, (3) Lack of healthcare reform expertise, (4) Healthcare has grown and so have the companies.
What are the goals of MTM? (1) Improve collaboration among healthcare professionals, (2) Enhance communication between patients and healthcare team, (3) Optimize medication use.
What are the benefits of MTM? (1) Prevention of ADE, (2) Improved reliability, and (3) Enable patients to become active with self-management.
What is a health care cost - wage trade off? Employers' contribution to the health insurance premium is really workers' compensation in another form.
What is a health care cost - public service trade off? The burden of government-provided health coverage falls on the average citizen.
What are the two proposed solutions to overcome the myth of shared responsibility? (1) Centerpiece of reform is likely employer mandate and (2) Employers should be removed from health care.
What are the five different kinds of distortions in the health care market? (1) Asymmetry of information between clinicians and patients, (2) Clinicians dual roles, (3) Effect of insurance reducing cost, (4) Tax subsidies that have similar effect, and (5) Monopoly power.
What is a price wedge distortion? The effect of insurance in reducing the apparent cost of health care services to patients.
What is medical commons? What is its relationship to moral hazard? Medical commons refers to the insured and available capacity. Medical commons was approaching depletion because of free access and moral hazard.
What are the three solutions provided by Hiatt to overcome the problem of Medical Commons? (1) Evidence based medicine, (2) National priority setting, and (3) Expansion of health care to include detriments of health with a focus on prevention.
Explain the RAND Health Insurance experiment. What were three major conclusions from the experiment? (1) Cost sharing patients spent less, (2) No significant difference on health (except for poor and sick), and (3) Cost sharing decreases utilization.
What is Consumer Choice Health Plan? Proposal involving controlling costs through competition by health insurances. Existing tax incentive system would be eliminated.
Examples for highest potential for cost savings: Payment reform, effectiveness review for new drugs and forms, EMR, improved care of patients with chronic conditions.
Examples for intermediate potential for cost savings: Restructered end-of-life care, consumerism, substantially reduced administrative costs.
Examples for lowest potential for cost savings: Malpractice reform, drug pricing reform, enhanced primary prevention activities.
What are the six methods suggested by the authors to reduce waste in health care? (1) Failures of care delivery, (2) Failures of care coordination, (3) Overtreatment, (4) Administrative complexity, (5) Pricing failures, (6) Fraud and abuse.
What is the wedges model in reducing health care waste? A current projection of health care spending.
What are the two main challenges in providing MTM services? (1) Lack of time and (2) Inadequate compensation
What are the characteristics of pharmacists who were ready to provide MTM service? Willingness based on drug cost. Newer practitioners were willing to accept lower compensation, store owners.
What is the difference between human factor and system factor? Human factors - physiologic, psychological System factors - training, computer software design, workflow, environmental conditions
What are the various medication error reporting methods used? Traditional hospital wide incident reports, potential chemotherapy errors corrected by pharmacists before administration, dispensing errors recorded prior to medication leaving pharmacy, anonymous reporting via case number, voluntary practitioner reports
What are the two techniques used for continuous quality improvement in hospitals? Effect analysis and outcomes research
What are the two strategies that have repeatedly shown to decrease medication errors? CPOE, pharmacists participation in medical rounds
What is the difference between adherence and pharmacoadherence? Adherence - patient follows medical treatment Pharmacoadherence - patient follows medication regimen
What are the various strategies to improve pharmacoadherence? (1) Improve medication access, (2) Increase knowledge and skills with medication and disease, and (3) Increase motivation to adhere. Technical, Educational, Behavioral, Affective, and Multimodal interventions.
Explain the four step approach proposed by American Public Health Association to promote adherence to medications? (1) Assessment of factors influencing adherence, (2) therapeutic alliance,(3) adherence assessment, and (4) multiple interventions.
Explain the steps taken by the American Psychological Association to address the issue of adherence? (1) Regimen understanding, (2) Adherence confidence, (3) Remember to take meds, (4) Incorporate meds into daily routine, and (5) Maintain adherence.
What is the difference between primary, secondary, and tertiary public health prevention activities? Primary decreases incidence and occurrence, Secondary decreases severity or progression, and Tertiary treats or rehabilitates.
Which pharmacy organization publishes Pharmacy Today? American Pharmacists Association (APhA)
Which pharmacy organization has a journal, formulary handbook, and international pharmaceutical abstracts? American Society of Health System Pharmacists (ASHP)
Which pharmacy organization provides continuing education through "America's Pharmacist?" National Community Pharmacists Association (NCPA)
Created by: sdeck86