The findings of low patient adherence and the impact of adherence on relapses and healthcare resource utilization strongly suggest opportunities to reduce healthcare resource utilization and healthcare costs among RRMS patients taking interferon-beta therapy. Efforts should be undertaken to understand and improve medication-taking behaviour in this population so as to minimize the negative impacts of RRMS on patients while reducing unnecessary direct and indirect costs to treat disease exacerbations.

BACKGROUND Epoprostenol and treprostinil are intravenous prostacyclin medications used to treat pulmonary arterial hypertension (PAH). This survey explored hospital policies regarding prostacyclin infusions, and investigated the type and frequency of errors that occurred in the inpatient setting. METHODS Information on prostacyclin infusion policies and inpatient errors was obtained through detailed interviews with 18 PAH nurses, and through an electronic survey completed by 97 PAH clinicians. RESULTS The electronic survey respondents reported wide variability in prostacyclin infusion policies, including variability in the use of home vs hospital infusion pumps, and variability in the use and storage of back-up epoprostenol and treprostinil. Serious or potentially serious errors in medication administration were reported by 68% of survey respondents. The most common error types (reported by ≥25%), included: incorrect cassette placed in the pump; inaccurate pump programming; errant drug dosing; and inadvertent cessation of the pump. Nine errors, all at different centers, were believed to have contributed to patient death. In the separate interviews with the PAH nurses, 94% reported serious errors. These errors prompted many of the centers to implement policy changes in an attempt to reduce future errors, improve safety and optimize patient outcomes. CONCLUSIONS These findings suggest that prostacyclin infusion therapy is problematic and that an opportunity exists to improve safety. The development of standardized treatment guidelines should be considered.

BACKGROUND-Epoprostenol and treprostinil are intravenous prostacyclin medications used to treat pulmonary arterial hypertension (PAH). This survey explored hospital policies regarding prostacyclin infusions, and investigated the type and frequency of errors that occurred in the inpatient setting. METHODS-Information on prostacyclin infusion policies and inpatient errors was obtained through detailed interviews with 18 PAH nurses, and through an electronic survey completed by 97 PAH clinicians. RESULTS-The electronic survey respondents reported wide variability in prostacyclin infusion policies, including variability in the use of home vs hospital infusion pumps, and variability in the use and storage of backup epoprostenol and treprostinil. Serious or potentially serious errors in medication administration were reported by 68% of survey respondents. The most common error types (reported by ≥25%), included: incorrect cassette placed in the pump; inaccurate pump programming; errant drug dosing; and inadvertent cessation of the pump. Nine errors, all at different centers, were believed to have contributed to patient death. In the separate interviews with the PAH nurses, 94% reported serious errors. These errors prompted many of the centers to implement policy changes in an attempt to reduce future errors, improve safety and optimize patient outcomes. CONCLUSIONS-These findings suggest that prostacyclin infusion therapy is problematic and that an opportunity exists to improve safety. The development of standardized treatment guidelines should be considered.

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DedicationThis dissertation is dedicated to my wife Debbie who has graced me with companionship, love, and support for 33 years. I also dedicate this work to my daughter AbstractThe stated mission of the Board of Pharmaceutical Specialties (BPS) with regard to specialization is, via board certification, to recognize specialty areas, define skill standards for those specialty areas, and evaluate the knowledge and skills of individual Pharmacy specialists. The perceived or real benefits to the pharmacist of pursuing board certification are unknown. These benefits can be evaluated by separating into values (valences) and instrumentalities, the latter of which is the perceived or known probability that a performance will lead to an outcome. The primary purpose of this study was to determine the differences in values and instrumentalities perceived by the pharmacist, and differing calculated forces of motivation, using an Expectancy Valence equation, between board certified pharmacists and those who were not.A survey instrument, the Advanced Certification Index for Pharmacists (ACI-P), was designed to test instrumentalities, values, and calculated force of motivation. The ACI-P was deployed via electronic mail and the internet in cooperation with four major Pharmacy organizations and the Board of Pharmaceutical Specialties. Four direct comparisons between the two groups were completed. These were instrumentality, valence, valence-minus-instrumentality and valence-times-instrumentality. Additionally, the components of the valence and instrumentality products (the VI Scores) were multiplied by expectancy (anticipated chance of success of an effort leading to successful performance) resulting in a force of motivation calculation for each pharmacist's score. Validation and reliability of the ACI-P was confirmed via parallel axis analysis and Cronbach's alpha reliability coefficient. There were two factors or domains found in the data and these were Professional, Career and Personal (PCP) and Financial Support (FS). Cronbach's alpha for the PCP factor or domain was 0.94 and the FS domain had an alpha of 0.81. The constructs were validated and the items addressed within the constructs of PCP and FS were reliable. The overall Cronbach's alpha reliability coefficient for the ACI-P was 0.94.In the four major comparisons, there were significant differences between nonboard certified and board certified pharmacists.The primary value used for the motivational force calculation was based on valence-times-instrumentality-times-expectancy. The valence-times-instrumentality value was the VI score or VIS. The summed VI scores for the non-board certified pharmacists were in general lower (303.54; SD 101) than those for the board certified pharmacists (343.82; SD 83), and these were statistically different (t= -8.03, p<.0001).The overall expectancy mean for non-board certified pharmacists was 4.05 and 4.4 for board certified pharmacists (5-point Likert scale), and these were significantly different (t = -9.16, p<.0001).The overall mo...