BACKGROUND: Multi-tier copayment designs in pharmacy benefit plans are intended to steer patients and prescribers to preferred drug therapies that have lower out-of-pocket costs for patients.OBJECTIVE: To describe and assess physicians' prescribing experiences and opinions in a multi-tier, primarily 3-tier formulary environment in 2 Midwestern states.METHODS: This was a cross-sectional survey of physicians practicing in either Minnesota or North Dakota. A packet consisting of a survey instrument, a cover letter, and a postage-paid return envelope was mailed to a random sample of 690 physician members of the Minnesota Medical Assoc iation (n = 460, 5.1% of members) or the North Dakota Medical Association (n = 230, 25.6% of members). Surveys were mailed between March and May 2006. Nonresponders were mailed up to 2 additional surveys. Survey items included practice specialty, sources used to obtain drug information, perceived importance of cost containment actions (e.g., prescribing drug with lowest total cost, prescribing drug that minimizes patient out-of-pocket cost), and how often the physician was personally aware of the following when writing a prescription: identity of the patient's insurer, patient's pharmacy benefit structure, preferred medications on the insurer's formulary, patient's copayment (out-of-pocket cost) responsibility, and list price of the medication.RESULTS: The survey response rate was 49.8% (296 of 594). The results were as follows: 93.5% of respondents agreed that it was important to prescribe the drug that would minimize the patient's out-of-pocket costs, 73.2% agreed that it was important to discuss out-of-pocket medication costs with patients, 81.8% of respondents agreed that it was important to prescribe the drug with the lowest total costs, and 33.3% of respondents believed that it was their responsibility to prescribe a preferred (formulary) medication. According to the survey, 61.6% of respondents were rarely or never aware of their patient's copayment amounts, and 42.4% were rarely or never aware of the list price of the medication. Physician specialty was associated with the awareness of the identity of the patient's insurer (generalists, 41.1% vs. specialists, 19.2%; P = 0.001) and use of personal digital assistant (PDA) when prescribing (generalists, 38.9% vs. specialists, 21.1%; P = 0.005).CONCLUSION: Physicians who responded to this survey believed that it was important to prescribe drugs that would minimize patients' prescription copayments, but they were often unaware of the preferred medications on the formulary, the patients' copayment amounts, or the price of the drugs prescribed.
Numerous articles have described the methodologies used and outcomes achieved with the intrathecal (IT) administration of morphine for pain. However, only one case report has been published that describes converting a patient's IT morphine to an oral regimen. This case report describes the experience of converting a patient's IT morphine to oral morphine and discusses the scarcity of published data to validate suggested equianalgesic intraspinal morphine recommendations. The calculated equianalgesic oral to IT ratio in this case was 12:1. This is substantially lower than the 300:1 ratio published by Krames and the 90:1 ratio employed by a commercially available software program for calculating equianalgesic opioid doses. We recommend caution when applying existing guidelines for conversion of morphine from an IT to an oral regimen.
English Considering the period 1969-1998 and then building upon the detailed examination of research documents in the period 1893-1969 in two previous articles, this article seeks to complete consideration of how international education has been defined over the course of a century. Utilizing a matrix involving the concepts of international understanding and world citizenship, the article then seeks to place the major research figures of that century within a suggested framework. French En se concentrant sur la période allant de 1969 à 1998 et en se basant sur deux articles précédemment publiés qui examinaient en détail les travaux de recherche effectués entre 1893 et 1969, cet article tente de compléter l'examen des façons dont l'éducation internationale a été définie au cours d'un siècle. En utilisant un tableau comprenant les concepts de compréhension internationale et de citoyenneté mondiale, cet article tente de placer les principaux chercheurs de cette période dans un cadre suggéré. Spanish Este artículo intenta completar el análisis de las formas en que se ha definido a la educación internacional durante más de un siglo, considerando el período 1969-1998, y basándose en dos artículos anteriores que examinaron detalladamente los trabajos de investigación llevados a cabo entre 1893 y 1969. Se ha construido una matriz-marco con dos conceptos principales: entendimiento internacional y civismo global, y se ha ubicado en este marco a las figuras más destacadas en el terreno de la investigación durante el período estudiado.
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