The University of Toledo

Graduate Student Research

Thesis Projects in Health Outcomes and Socioeconomic Sciences

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Title: Racial and Ethnic Disparities in Quality of Health Care among Adults with Diabetes in the United States
Graduate Student: Yan-Jun Zhang
Committee Members: Holiday-Goodman, M., Amialchuk, A., and Jung, R.
Year: May 2009

Studies have shown that racial and ethnic disparities in healthcare among adults with diabetes persist even after controlling for demographic and socioeconomic factors. To eliminate healthcare disparities in the U.S., monitoring and reporting the most recent trends of disparities and critically important. In addition, no studies were found in the literature that focused on disparities in timeliness and patient centeredness of health care using retrospective database. The objective of this study was to examine the most recent racial and ethnic disparities in quality of health care (receipt of diabetes services, timeliness, and patient centeredness) among adults with diabetes in the U.S. The 2005 and 2006 Medical Expenditure Panel Survey (MEPS) data files including the Diabetes Care Survey and the Self-Administered Questionnaire were used. The racial and ethnic disparities in receipt of recommended diabetes services, timeliness and patient centeredness were examined. Statistical analyses included the chi-square test and logistic regression to evaluate the disparities before and after controlling for the confounding factors (age, gender, family income, education, health insurance coverage, residential location, and language spoken most often at home).In 2005-2006, the racial and ethnic disparities in quality of health care among U.S. adults with diabetes still exist. Blacks and Hispanics were less likely to receive recommended diabetes services and patient-centered health care than white Americans. The only exception was in regard to foot examinations. There was no statistically significant difference in timeliness of health care among racial and ethnic groups. Racial and ethnic disparities in receipt of recommended diabetes services and patient centeredness of health care among adults with diabetes remained in the U.S. in 2005-2006. Age, family income, health insurance coverage, education, residential location, and English-speaking were correlated with racial and ethnic disparities. As this study focused on disparities among Whites, Blacks and Hispanics, future studies comparing possible differences among other U.S. racial groups are needed.

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Title: Medication Utilization and Adherence Patterns among Toledo Lucas County CareNet Patients

Graduate Student: Maithili Deshpande
Committee Members: Holiday-Goodman, M., Powers, M., and White, D

Year: May 2009

The United States has about 46 million uninsured Americans, making them vulnerable to a number of diseases.  As the cost of prescription medications increases, many lower income and/or uninsured patients cannot afford prescription medications and hence may not adhere to their medication regimen.  Toledo/Lucas County CareNet and an independent pharmacy chain, The Pharmacy Counter, in Toledo, Ohio help the underserved community to obtain prescription medications at a nominal cost through the ‘We Care Pricing’ program.  The purpose of this study was to evaluate the medication utilization and adherence patterns among Toledo/Lucas County CareNet patients using the ‘We Care Pricing’ program.  A retrospective study was developed to measure adherence and utilization of this prescription program.  Data from June 2008-January 2009 was obtained for 211 patients from The Pharmacy Counter database and included the age, price paid by the patient, zip code, refill records and medications prescribed.  Descriptive statistics were performed to analyze the utilization of the prescription program.  Medication adherence was measured using Medication Possession Ratio (MPR). Differences in adherence by medications were analyzed using one way ANOVA.  Differences in adherence based on disease state were also analyzed using one way ANOVA.  A Pearson correlation and one way ANOVA was used to analyze the correlations between medication adherence and age, price paid by the patient, location of pharmacy and location of patient.  Data analysis was performed using SPSS version 16.0.  The results of the study showed that of the 210 patients included in the analysis 36.7% were 51-60 years old.  Over 80% of the patients enrolled in the program paid $1-$10 for their prescription medications.  The average adherence to diabetes, hypertension, hyperlipidemia and mental health medications was found to be 0.83, 0.95, 0.87 and 0.87 respectively.  Age, amount paid by the patient, location of pharmacy and location of patient did not seem to correlate with adherence to prescription medications.  Those patients for whom MPR was calculated showed high adherence rate compared to other studies.

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Title: Effects of Demographic Factors and Socioeconomic Variables on Healthcare Resource Utilization and Expenditures for Breast Cancer Patients using MEPS 2004.

Graduate Student: Lin Zhan
Committee Members Nair, R., Holiday-Goodman, M., Pinto, S.and Black, C

Year: May 2008

To examine the influence of demographic and socioeconomic factors on the healthcare resource utilization and expenditures for breast cancer patients in MEPS 2004. A retrospective study using a secondary database- 2004 Medical Expenditures Panel Survey (MEPS) was conducted. Breast cancer patients (ICD-9-CM= 174, 175, V10.3, 233 and CCC code= 024) with age ³ 18 years were included in the analysis. Negative binominal regression and generalized linear-gamma model were employed to examine how demographic and socioeconomic variables predicted the difference in total healthcare resource utilization and total expenditures. In order to generalize the results to the whole US population, sample weight from MEPS was utilized. One hundred twenty-one female patients were included in the study. Approximately 52% of them were over 65 years old; 85% were Caucasians; 53% were married; 27% had a Bachelor’s degree or above; 76% were urban; 62% were unemployed; 68% had high family income; and 98% had insurance. Those that used more healthcare resources and expenditures were either, below 64 years of age, unmarried, less educated, employed, in a family size over four, of lower family income and insured. However, neither of these variables was significantly related to the dependent variables. Race and employment status were statistically significant factors accounting for higher healthcare expenditures (p<0.05). This study provides insight into factors related to healthcare resource utilization and expenditures. Demographic and socioeconomic factors did influence healthcare resource utilization and expenditures differently.

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Title: Prescription Medication Needs Assessment of Toledo/Lucas County CareNet Patients

Graduate Student: Christina Springer
Committee Members: Holiday-Goodman, M., Pinto, S., Nair, R. and Ruma,J.

Year: May 2008

Toledo/Lucas County CareNet patients do not have prescription drug coverage. The purpose of this study is to identify literature through a systematic review that provides information on programs in which patients without prescription drug coverage can access prescription medications and to reveal the prescription access and barriers that CareNet patients face.The systematic review included literature published from January 2001 through January 2008. Sixty-nine articles and studies were identified through a search of databases, journals and websites. Researchers conducted 210 personal interviews of CareNet patients using a survey instrument. The interviews were conducted where CareNet patients visit their primary care physicians. The identified literature was designed to serve as a comprehensive reference tool to inform readers on how to improve uninsured patients’ access to prescription medications. Almost half of CareNet patients lack access to prescription medications and have barriers to access prescription medications that are financial and informational in nature. 

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Title: Job Satisfaction of Pharmacy Technicians.

Graduate Student: Robert Bechtol
Committee Members:  Holiday-Goodman, M., Powers, M. and White, D.

Year: May 2007

The purpose of the study was to examine the difference between certified and non-certified registered pharmacy technicians’ job satisfaction and their satisfaction with specific facets of job satisfaction.  The researcher used a mailed questionnaire to gain valuable information from the pharmacy technicians who participated in the study. The final results and conclusions from the study showed that there was no statistically significant difference in overall job satisfaction based on the certification status of the pharmacy technicians.  Communication and operating procedures were the only facets in which there was a marginal significant difference.  Overall job satisfaction was strongly significantly affected by work setting and marginally affected by length of time with current employer.Technicians in independent community settings had significantly higher levels of overall job satisfaction than those in hospital settings.  The study concluded that although there was no statistically significant difference between certified and non-certified technicians in job satisfaction, pharmacy technicians were generally satisfied with their job and work environment.

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Title: A Systemic Review of Diabetes Disease Management Programs as a Strategy for Clinical Outcomes Improvement and Cost Containment

Graduate Student: Youngsook Chung
Committee Members: Dr. Monica Holiday-Goodman, Dr. Sharrel Pinto, and Dr. James Price

Year: May 2006

The purpose of Youngsook Chung’s thesis was to systematically evaluate published evidence regarding the effectiveness of diabetes disease management programs by pharmacists, physicians and nurses as a strategy for clinical outcomes improvement and cost containment. This was done by an electronic search of the MEDLINE database and a hand search of journals that fit the topic area. Thirty-six studies met the inclusion criteria and were reviewed. Based on three studies it is likely that most interventions will show improvement in overall quality of care for diabetes patients as well as reducing overall costs. Reimbursement of these interventions can encourage the adoption of disease management programs which will lead to the better quality of care and reduced long term costs.

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Title: Assessing Change in Cultural Competence Knowledge and Confidence of Pharmacy Students

Graduate Student: Jagannath Muzumdar
Committee Members: Dr. Monica Holiday-Goodman, Dr. Mary Powers, and Dr. Curtis Black

Year: May 2006

The study was done by Mr. Jagannath Muzumdar in the Fall 2005 and Spring 2006. Mr. Muzumdar’s study incorporated one hundred and five fourth-year pharmacy students from the University of Toledo, College of Pharmacy. The purpose of the study was to assess the change in cultural competence knowledge and confidence of pharmacy students to provide culturally competent care after exposure to cultural competence modules throughout several courses in the fourth-year pharmacy curriculum. The study findings may be helpful in proposing modifications to the curriculum that will enhance the cultural competence knowledge and confidence of pharmacy students. The researcher used a self-administered questionnaire and focus group interviews to gain valuable information from the pharmacy students who participated in the study. The final results and conclusions from the study showed that pharmacy students’ knowledge of cultural competence and confidence in providing culturally competent care increased with the use of educational sessions/modules. Also, the study showed that gender and ethnicity did not have any significant effects on the change in the cultural competence knowledge and confidence of pharmacy students, but there proved to be a significant effect between the students who were not fluent in a language other than English and the change in the cultural competence knowledge and confidence. In conclusion, with increasing diversity in the population of United States, pharmacy schools must address the need to provide cultural competency information to pharmacy students to ensure provision of quality pharmaceutical care to all their patients.

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Title: Pharmacists’ Counseling Practices for Obese Patients

Graduate Student: Zaina Qureshi
Committee Members: Dr. Monica Holiday-Goodman, Dr. Sharrel Pinto, and Dr. Mary Powers

Year: May 2006

The purpose of the study was to identify personal factors that affect pharmacists’ counseling about obesity, determine the practice barriers faced by pharmacist’s to counseling about obesity as well as propose ways to overcome barriers to counseling. A self-administered mail survey was the data collection method employed. Pharmacist’s counseled rarely to sometimes about obesity. The study showed that lack of time, lack of expertise in counseling as well as lack of interest in counseling had a significant effect on pharmacists’ counseling frequency and pharmacist’s frequency of counseling was significantly affected by variables such as confidence in achieving positive outcomes in obese patients by adherence to prescribed anti-obesity medications as well as counseling about proper use of over-the-counter herbal therapies. Eliminating the barriers to counseling would improve pharmacist’s counseling about obesity and help them achieve positive health outcomes among obese patients.