Pharmacy and Pharmaceutical Sciences Commons^™

The Association Of Long Working Hours And The Use Of Prescription Sedatives Among U.S. Workers., Emmanuel Ezekekwu

Electronic Theses and Dissertations

BACKGROUND: Meeting the needs of a round-the-clock and globalized society has led to an increase in long working hours. This trend has been accompanied by a corresponding rise in sleep disorders and subsequent use of sedating medications. Overtime hours have been associated with adverse health outcomes such as cardiovascular diseases, symptoms of psychological distress, and health behaviors, including risky intake of alcohol and smoking. Hence, the main objectives of this three-paper dissertation were to examine the multi-faceted relationship between working hours, the use of prescription sleep aids, the onset of psychological distress, and the use of health care services. METHODS: …

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

MD Honors Theses

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level Deprivation …

Cost-Effectiveness Analysis Of Tpmt Genotype-Guided Azathioprine Treatment Compared To Standard Treatment For Patients With Moderate/Severe Ulcerative Colitis, Ali Unsal

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based azathioprine (AZA) compared to standard AZA therapy for ulcerative colitis (UC) patients in Canada. A patient-level Microsimulation model was developed to compare the lifetime costs and quality-adjusted life years (QALYs) gained by a hypothetical cohort of UC patients with age and sex characteristics. The parameters used in the model were derived from the published literature and costs from the Ontario Schedules of Payments and published sources. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard AZA, PGx-based AZA care was the dominant strategy with 0.17 incremental QALYs …

Pharmacists' Role In Opioid Use Disorder And Overdose Prevention And Treatment And Their Attitudes And Perceptions Towards Distributing Naloxone Under A Standing Order, Stephen C. Ijioma

Theses and Dissertations

Background: Opioids are a class of drugs that bind to opioid receptors (mu, delta, and kappa), located in the central and peripheral nervous systems, to exert responses such as analgesia, respiratory depression, euphoria, and miosis. The opioid epidemic is characterized in large part by an increase in opioid overdose deaths. Community pharmacists are one of the most accessible healthcare professionals who frequently interact with patients and can implement OUD and opioid overdose prevention strategies. Treatment for opioid overdose and OUD include naloxone for overdose deaths as well as medication-assisted treatment for OUD.

Objective: The specific aims of this thesis include …

Cost-Effectiveness Analysis Of Tisagenlecleucel, Blinatumomab, And Clofarabine For Treatment Of B-Cell Precursor Acute Lymphoblastic Leukemia, Kamron Lotfi

Pharmaceutical Sciences (MS) Theses

Acute lymphoblastic leukemia (ALL) is a common type of adolescent and young adult leukemia in the United States (U.S.). Patients who are refractory or relapsed after receiving two or more lines of systemic therapy have the option of taking tisagenlecleucel. Due to the high cost of this treatment, a cost-effectiveness analysis was performed to assess the treatments for tisagenlecleucel, clofarabine combination, and blinatumomab. Objectives

The objective of this study is to evaluate the cost-effectiveness of tisagenlecleucel; clofarabine, etoposide, cyclophosphamide; and blinatumomab for the treatment of relapse- refractory ALL for adolescents and young adults from the U.S. health care payer perspective. …

Association Of Incident Cancer To Low-Value Care And Healthcare Cost Burden Among Elderly Medicare Beneficiaries, Chibuzo Iloabuchi

Graduate Theses, Dissertations, and Problem Reports

In the United States (US), 25% of healthcare spending is considered wasteful because it is spent reimbursing low-value care. Low-value care is the utilization of healthcare services, medical tests, and procedures that have unclear or no clinical benefit to patients but still exposes them to risk. World-wide, low-value care imposes a significant economic burden on patients, payers, governments, and society. Cancer care among older adults > 65 years is one of the biggest drivers of healthcare expenditure in the US and accounts for nearly 40% of all spending, and low-value care among cancer patients is prevalent and contributes to the financial …

Health Outcomes And Utilization Associated With Renal Diseases In Patients With Cancer In The United States, Mitisha Dedhia

Theses and Dissertations

Background: Adverse events and impairments associated with cancer and its treatments causes worse outcomes. Increased incidence of renal diseases among cancer patients is of particular concern. Objective: To determine the risk factors for renal disease in cancer patients and compare healthcare costs, utilization and health-related quality of life (HRQoL) of cancer patients with a renal disease and cancer patients without renal diseases. Methods: Medical Expenditure Panel Survey files from 2009 – 2018 for cancer patients was used for this study. Multiple logistic regression, generalized linear model, Poisson regression and multiple linear regression for analyses after adjusting for demographic, socioeconomic and …

Understanding Elements Involved In Active Racial And Ethnic Minority Recruitment Practices For Biopharmaceutical-Sponsored Clinical Trials: A Socio-Ecological Qualitative Inquiry, Rebecca Rae Johnson

Seton Hall University Dissertations and Theses (ETDs)

Inequitable participation in clinical trials continues to be a problem, and trial populations do not always reflect the demographics of the population that the investigational product will ultimately be treating. Because genetic differences between racial and ethnic groups affect the safety and efficacy of new treatments, it is important that standard of care decisions are made based on a representative population. The purpose of this study is to understand the socio-ecological elements that are involved in the active implementation of racial and ethnic minority recruitment practices for biopharmaceutical-funded trials in the United States. This general qualitative study was both descriptive …

Asthma-Copd Overlap: Economic Burden And Medication Adherence, Mona Nili

Graduate Theses, Dissertations, and Problem Reports

In many older adults, asthma and chronic obstructive pulmonary disease (COPD) coexist as “Asthma-COPD overlap” (ACO). This dissertation pursued three Aims: 1) estimate the economic burden of ACO and its contributory factors; 2) evaluate the association of ACO to “cost-related medication nonadherence” (CRN); and 3) identify adherence trajectory patterns and examine the impact of initial maintenance therapies (IMT) type (inhaled corticosteroids monotherapy (ICS) vs. fixed-dose combination of ICS and long-acting beta agonist (ICS/LABA)) on adherence trajectory patterns among older adults Medicare Beneficiaries. The first and second Aims were cross-sectional studies by using Medicare Current Beneficiary Survey data. For the third …

Multimorbidity, Immune Checkpoint Inhibitor Use, And Healthcare Expenditures Among Older Patients With Late-Stage Melanoma, Pragya Rai

Graduate Theses, Dissertations, and Problem Reports

With decades of unchanged cancer care with no added survival benefit, immune checkpoint inhibitors (ICI) changed the treatment landscape of late-stage melanoma in 2011. A key factor in determining the use of ICIs is the presence of pre-existing chronic conditions, which can influence the outcome. However, the prevalence of multimorbidity (defined as presence of two or more chronic conditions) among older patients with late-stage melanoma remains unknown. It also remains unknown if the presence of multimorbidity factors into the use of ICIs. Hospital-related factors associated with ICI use have been studied. Yet, patient-level factors, such as age, sex, marital status, …

Utilization Of A Community Pharmacy-Based Service For The Treatment Of Uncomplicated Urinary Tract Infections In Scotland, Robert Borchardt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim …

Associations Among Healthcare Utilization And Binge Drinking, Ethan Grey, Chad Phalon, Anna Greene, Patricia Harmeyer, Kalyn Rosenberg, Cristine Griffing, Tom Delaney

Master of Public Health Culminating Projects

Objective. To examine associations among routine healthcare services and binge drinking in Vermont adults.

Methods. We analyzed a cross-sectional sample of randomly selected 6516 adults who participated in the self-reported 2017 Vermont Behavioral Risk Surveillance System survey. We estimated odds ratios for responses indicative of binge drinking in association with length of time since last routine checkup using a bivariate logistic regression model.

Results. Participants who reported binge drinking were 31% (OR = 0.69, 95% confidence interval [CI] = 0.56, 0.83) less likely to engage in a healthcare visit within the past year controlling for age, employment status, annual household …

Developing A Workflow To Evaluate Medications For Repurposing Using Health Claims Data: Application To Substance Use Disorders, Emily Ruth Hankosky

Theses and Dissertations--Pharmacy

Healthcare big data are a growing source of real-world data with which to identify and validate medications with repurposing potential. Previously, we developed a claims-based workflow to evaluate medications with potential to treat stimulant use disorders. In order to test the workflow, the framework was applied in the context of opioid use disorders (OUDs), for which there are medications with known efficacy. Using the Truven Marketscan Commercial Claims Database, a nested case-control analysis was conducted to determine the association between OUD medications (buprenorphine, naltrexone) and remission. Cases were defined as enrollees with a remission diagnosis and matched (1:4) to controls …

Impact Of Area-Under-The-Curve Monitoring For Vancomycin On Incidence Of Acute Kidney Injury In Orthopedic Patients, Kelli R. Keats

MPA/MPP/MPFM Capstone Projects

Vancomycin is an antibiotic used regularly in hospitals across the world. The most concerning adverse effect of vancomycin is its documented effect on kidney function. This study examines the impact of two dosing strategies of vancomycin on patients’ kidney function at the University of Kentucky Albert B. Chandler Medical Center. It specifically focuses on patients on the orthopedic service because these patients traditionally receive higher doses of vancomycin for longer periods of time due to the severity of their infections, which puts them at an increased risk of vancomycin-induced nephrotoxicity compared to other patients.

This study will serve as a …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Burden Of Lipohypertrophy Among Insulin Dependent Diabetes Mellitus Patients In China: An Analysis Of Outcomes And Impact Of Pen Needle Reimbursement Policy, Arthi Chandran

Dissertations and Theses

Background

Diabetes is a global epidemic and with an aging population accompanied by rapid urbanization China ranks highest in disease prevalence and associated burden. Independent of diabetes type, insulin is an eventual and costly requirement for disease management. The consequences of insulin administration however are poorly understood. Lipohypertrophy (LH) is one such consequence. It is hypothesized that method of insulin delivery and poor delivery technique are significant risk factors for this condition which is believed to alter insulin pharmacodynamics. Subsequently, insulin pen needles are a critical component of care however access to pen needles varies across China.

Objective

The objective …

Incidence, Risk Factors, And Prediction Of Gastrointestinal And Intracranial Bleeding In A Cohort Of Older Veterans Prescribed Oral Anticoagulants, Angela Laurio

Dissertations and Theses

ABSTRACT

Incidence, Risk Factors, and Prediction of Gastrointestinal and

Intracranial Bleeding in a Cohort of Older Veterans Prescribed Oral Anticoagulants

by

Angela L. Laurio

Advisor: Marianne (Mimi) C. Fahs, PhD, MPH

Objectives:

The objectives of this dissertation were to: (1) describe and compare the incidence and odds of gastrointestinal and intracranial bleeding in veterans age 50 to 89 who were prescribed warfarin, direct oral anticoagulants, or no oral anticoagulants; (2) identify risk factors for gastrointestinal and intracranial bleeding among older veterans prescribed oral anticoagulants, and to calculate the relative risk of bleeding over time through time-to-event analysis; and (3) develop …

Economic Burden Of Renal Cell Carcinoma (Rcc) And Treatment Patterns, Overall Survival And Healthcare Costs Among Older Metastatic Rcc Patients, Hrishikesh P. Kale

Theses and Dissertations

Background

Renal cell carcinoma (RCC) is the most common type of kidney cancer. Patients diagnosed with metastatic RCC (mRCC) have shorter overall survival compared to those diagnosed at earlier stages. Several targeted therapies, which cost from $7,000 - $16,000 per month have been approved since 2005 to treat mRCC. In addition, there is a growing interest in the use of cytoreductive nephrectomy (CN) with targeted therapies among mRCC patients. However, little is known regarding the economic burden of RCC and role of CN and prescribing patterns of targeted therapies among older mRCC patients.

Objectives

1) To assess the economic burden …

Burden Of Illness And Pharmacoeconomic Evaluation Of Lumacaftor/Ivacaftor In Cystic Fibrosis, Pratyusha Vadagam

Electronic Theses and Dissertations

Objectives: (1) To estimate the burden of illness in cystic fibrosis (CF) using 2010-2014 Medical Expenditure Panel Survey (MEPS) data, and (2) to conduct a pharmacoeconomic evaluation of lumacaftor/ivacaftor in the treatment of CF.

Methods: The study was conducted in two parts. Part 1 involved a retrospective analysis using individuals in MEPS database with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of 277.00 for a principal diagnosis of CF. Dependent variables were cumulative and out-of-pocket (OOP) expenditures and independent variables included patient demographics and clinical characteristics. Unweighted and weighted estimates of expenditure in CF group, …

Understanding Over-The-Counter Medication Use And Decision-Making Among Community-Dwelling Us Older Adults: A Mixed-Methods Approach, Yoshita Paliwal

Theses and Dissertations

Introduction

Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in …

Analysis Of Out-Of-Pocket Expenditures Of Oral Oncologics For Tennessee Recipients Of Medicare Part D, Eve Carolyn Elias

Theses and Dissertations (ETD)

Background: There are few studies that examine patients' costs of oral oncology drugs from Medicare Part D plan providers. These drugs can impose a financial burden to beneficiaries, and, due to their cost, place beneficiaries in the coverage gap in a short period of time. In addition to examining costs, there is little published concerning the potential impact of drug utilization management techniques on access to these drugs in Medicare Part D plans. This study examined the roles of prior authorization, step-therapy, and placement of drugs in higher formulary tiers on patients' out-of-pocket costs, and access to therapy.

Methods …

Retirees And Pharmaceutical Costs: Is There Really A Crisis?, Justine Maiello

Seton Hall University Dissertations and Theses (ETDs)

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