Social and Behavioral Aspects

of Pharmaceutical Care

Mickey C. Smith
Albert I. Wertheimer
Editors

Pharmaceutical Products Press

An Imprint of the Haworth Press, Inc.
New York • London
 CONTENTS

About the Editors xvii

Contributors xix
Foreword xxxi

Henri R. Manasse Jr.

PARTI: THE SICKNESS CAREER

SECTION A: CONCEPTS OF HEALTH AND ILLNESS

Chapter 1. Definitions and Meaning of Health 3

Richard M. Schulz
HealthA. Holdford
The Paradox ofDavid 3
The Meaning of Health 4
Definitions of Health 7
Health, Pharmaceutical Care, and Quality of Care
Assessment 8
Health Beliefs 11
A Model of Health Behavior 13
Wellness and Health 15
Health Promotion and Disease Prevention 15
Conclusion 17

Chapter 2. Illness, Sickness, and Disease 21

Mickey C. Smith
Introduction 21
Definitions and Determinants of 111 Health 22
Behavior in Health and Sickness 24
The Pharmacist and Patient Behavior 36
Summary 36
SECTION B: PATIENT RESPONSES TO SYMPTOMS

Chapter 3. The Meaning of Signs and Symptoms 41

Dennis A. Frate
Juliet B. Frate
Introduction 41
Empirical Data 49
Discussion 60
Summary 62

Chapter 4. Acute vs. Chronic Problems 65

Peter D. Hurd
Introduction 65
Chronic and Acute Symptoms 66
Attribution Errors and Symptoms 66
Symptoms and Change with Chronic Disease 74
Examples of Symptoms in Situations 79
Some Limitations of This Approach 80
Summary 81

SECTION C: CHOOSING A SOURCE OF CARE

Chapter 5. Images of Pharmacists and Pharmacies 85

Sheryl L. Szeinbach
Introduction 85
Background Information 85
What Is Image? 86
Changes Affecting Pharmacy 87
Conceptual Framework 88
Corporate Image 89
Market Image 90
Professional Image 90
Recent Studies on Professionalism and Image
in Pharmacy 91
Strategies for Image Improvement 94
Conclusion 96
Chapter 6. Other Health Providers and the Pharmacist 99
Bernard Sorofman
Toni Tripp-Reimer
Richard Dehn
Mary Zwygart-Stauffacher
Introduction 99
Continuity of Health Care 100
Changing Health Care Environment 100
Professionals in Society 103
The Adaptation of Medicine 105
Emergence of Physician Assistants 106
The Evolution of Nursing 10 8
The Practice of Dentistry 111
Other Healing Professions 112
Prescribing and Dispensing 112
Pharmacists and the Health Care Team 115

Chapter 7. Unorthodox Healing Systems 123

Albert I. Wertheitner
Introduction 123
Physical Therapies 125
Hydrotherapy 131
Nutrition 133
Plant-Based Therapies 135
Wave and Radiation 137
Mind and Spirit Healing 138
Self-Exercise 143
Comprehensive Systems 143
Summary 145

SECTION D: CHOOSING A THERAPEUTIC AGENT

Chapter 8. Determinants of Prescribing Behavior 149

Dennis W. Raisch
Introduction: Why Are We Interested? 149
Prescribing Models/Theories: How Are Prescribing
Decisions Made? 150
Methods Used to Influence Prescribing 159
 Administrative Programs Used to Affect Prescribing:
Limiting Prescriber Choices 160
Changing Prescribing Knowledge and Drug Assessment:
How Can Pharmacists Educate Prescribers to Better
Utilize Drugs? 163
Designing Programs to Improve Prescribing: A Model
of Methods for Influencing Prescribing 169
Quality of Care Issues 174
Implications for Practice: Putting It All Together 175
Conclusions 176

Chapter 9. Pharmacists' Performance in Drug Product

Selection and Therapeutic Interchange 185
Nancy J. W. Lewis
Steven Erickson

Introduction 185
Drug Product Selection 185
Therapeutic Interchange 197
Conclusions 207

Chapter 10. Interprofessional Relations in Drug Therapy

Decisions 213
Jennifer A. Gowan
Louis Roller
Alistair Lloyd

Introduction 213
Formal and Informal Networks 215
Improvement of Therapeutic Outcomes 218
Barriers to Interprofessional Relations 222
Communication Skills to Improve Interprofessional
Relations 225
Patient, Prescriber, Pharmacist 230
Intervention 235
Conclusion 245
Chapter 11. Consumer Behavior Regarding the Choice
of Prescription and Nonprescription Medications 253
Michael Montagne
Lisa Ruby Basara
Introduction to Consumer Medication Choice 253
Consumer Behavior 254
General Consumer Behavior Models 255
Prescription Medications and Consumer Goods
Are Different 261
Studying Medication Use from a Social and Behavioral
Perspective 263
Prescription Medication Use 271
Nonprescription Medication Use 276
Providing Pharmaceutical Care to Medication Consumers 285
Conclusion 289

SECTION E: MEDICATION-TAKING BEHAVIOR

Chapter 12. Determinants of Medication Use 295

Mickey C. Smith
Introduction 295
The Case of Laxatives 296
Analyzing the Medication Use Process 299
The Case of Minor Tranquilizers 304
Prescribing Studies 305
Utilization Studies 307
Prescribing Dilemmas 314
Look Ahead 317
Summary 319

Chapter 13. Predicting and Detecting Noncompliance 323

Mickey C. Smith
Introduction 323
Noncompliance as a Behavioral Disease 323
Predicting Noncompliance 325
Just Ask Them! (In an Organized Way, of Course) 326
 The Health Belief Model Can Help 329
Detecting Noncompliance 330
Why All the Fuss About Compliance? 339
Conclusion 342

Chapter 14. Explaining and Changing Noncompliant

Behavior 351
Dale B. Christensen
The Significance of the Noncompliance Problem 351
Explaining Noncompliant Behavior 354
Changing Noncompliant Behavior 362
Types of Noncompliant Behavior 363
Compliance Enhancement in Tomorrow's World
of Pharmacy Practice 370
Concluding Thoughts 374

SECTION F: OUTCOMES OF PHARMACEUTICAL CARE

Chapter 15. Clinical Outcomes 379

Charles E. Daniels
Introduction 379
Definition of Clinical Outcomes 380
Monitoring Outcomes 380
Disease State Management 382
Conclusion 383

Chapter 16. Economic Outcomes 385

Brian G. Ortmeier
Introduction 385
Perspective 386
Defining Costs and Consequences 388
Cost/Benefit Valuation 390
Types of Economic Analyses 392
Critical Evaluation of the Health Economic Literature 398
Applications for Health Economic Research 399
Chapter 17. Humanistic Outcomes 403
Stephen Joel Coons
Jeffrey A. Johnson
Introduction 403
Quality of Life 405
Patient Satisfaction 411
Quality of Life and Patient Satisfaction: Measurement
Issues 412
Humanistic Outcomes and Pharmaceutical Care 416
Summary and Conclusion 421
Appendix I: RAND 36-Item Health Survey 1.0 423
Appendix II: Short-Form Patient Satisfaction
Questionnaire (PSQ-18) 431
Appendix III: Satisfaction with Pharmacy Services
Questionnaire 435
PART II: SPECIAL CLASSES OF PATIENTS
Chapter 18. Children and Medicines 449
Patricia J. Bush
Introduction 449
How Children Learn 451
Children's Medicine-Related Beliefs and Behaviors 456
Helping Children Learn About Medicines 464
Chapter 19. Adolescents and College Students 473
Tracy S. Portner
Introduction 473
Social and Health Issues 474
Self-Care Activities 483
Illness and Medication Use in Young Adults 484
Sources of Self-Care and OTC Product Information 487
Health Services Utilization 491
Role of the Family in Illness Care 492
Adolescents and Chronic Illness 493
Compliance in Adolescents 498
Minors' Legal Rights to Care 499
Pharmacists: Make a Special Effort 503
Conclusion 505
Chapter 20. Ambulatory Elderly 515
Jack E. Fincham
Introduction 515
Demographics 516
Social and Behavioral Concerns 519
General Health Concerns 522
Medication-Specific Concerns 524
Conclusion and Commentary 531

Chapter 21. Long-Term Pharmaceutical Care: Social

and Professional Implications 537
Royce A. Burruss
Norman V. Carroll
Introduction 537
Long-Term Care: The Nursing Home 538
Long-Term Care: Assisted Living 541
Long-Term Care: Continuing Care Retirement Community 541
Long-Term Care: Home Health Care 542
Pharmaceutical Care: An Overview 544
The Case of AAA: Pharmaceutical Care in Action 548
Conclusion 555

Chapter 22. Hospitalized Patients 559

Andrew M. Peterson
Paul G. Pierpaoli
Introduction 559
Acute Health Care Services Revisited 559
The Hospitalized Patient: A Conceptual Basis of Care 563
Conclusion 579
Chapter 23. Pharmaceutical Care of Terminally
111 Patients 585
Arthur G. Lipman
Joni I. Berry
Introduction 585
Hospice Care 587
The Hospice Team 590
 The Pharmacist's Responsibility to Terminally 111 Patients 590
Hospice Pharmaceutical Care 593
Hospice Pharmacist Job Description 598
Principles of Palliative Care 600
Case Studies in Pharmaceutical Care of Terminally 111
Patients 605
Conclusion 607
Chapter 24. Mental Disorders 611
Julie Magno Zito
Introduction 611
Mental Disorders: Their Classification and Evaluation 614
Epidemiology of Mental Disorders 616
Selected Psychosocial Principles of Mental Disorder
Therapy 619
Antipsychotics for Psychosis and Other Disorders 623
Principles of Longitudinal Monitoring 627
Conclusion 629
Chapter 25. Cultural Issues in the Practice of Pharmacy 635
Pedro J. Lecca
Introduction 635
Cultural Practice Issues 637
Lack of Cultural Understanding 639
Holistic Assessment 640
Culturally Sensitive Practices 641
Culture and Pharmacy Management Practice 642
The Future of Culture in Your Practice 643
644
Cultural Training
644
Conclusion
PART III: REVIEW OF USEFUL CONCEPTS/MODELS
651
Chapter 26. A Macro View: Public Policy
Lon N. Larson
Background and Objectives
The Mechanisms of Action of Public Policies
The Demand for and Supply of Public Policy
 Approaches to Improving Health Status 659
Values in Health Care Services Delivery 662
Public Input and Participatory Democracy 669

Chapter 27. The "Rebirth" of Cognitive Services 675

Kent H. Summers
Introduction 675
The Evolution of Modern Pharmacy Practice 675
Gaining Reimbursement for Cognitive Services 691
Conclusion 706

Chapter 28. Recent Developments in Behavioral Medicine 715

Donna E. Dolinsky
What Is Behavioral Medicine? 715
What Is Health Psychology? 717
What Behaviors Are Related to Illness? 718
What Are Behavioral Medicine's Interventions? 725
Why Is Behavioral Medicine Important for Patients
and for the Health Care System? 729
Do the Nondrug Treatments of Behavioral Medicine
Have a Place in Pharmaceutical Care? 730
What Does This Mean for a Pharmacist? 731

Chapter 29. Expectations, Education, and Technology 737

Sheldon Xiaodong Kong
Stephanie Y. Crawford
Introduction 737
Expectations 739
Technology 749
Pharmacy Education 757
Conclusion 764

Chapter 30. Ethical Concerns in Drug Research 773

Kenneth A. Speranza Sr.
Amy M. Haddad
Introduction 773
Ethical Principles Underlying Drug Research 775
 Ethical Norms of Drug Research 781
Additional Considerations for the Practicing Pharmacist 791
Conclusion 794
Appendix A: The Nuremberg Code 794
Appendix B: Declaration of Helsinki 796

Epilogue 801
Albert I. Wertheimer
Index 809