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Perceptions and Opinions of Canadian Hospital Executives: RESULTS

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Of the 500 surveys distributed, 15 had the wrong address or could not be delivered for some other reason and were therefore omitted from the survey population. Overall, 272 (56.1%) of the 485 usable surveys were completed and returned. More than half of the respondents were women, almost two-thirds had at least 16 years of experience, and most had a master’s degree (Table 1). About half of the respondents were at the executive level of management, and a similar proportion were working in the hospital setting (Table 1). The demographic characteristics of the respondents were very similar to those of the entire CCHSE membership, except that a greater proportion of the survey population had completed a master’s program (72.0% versus 58.0%) (Ron Fraser, Coordinator, Information Systems, CCHSE; personal communication in writing; September 2003). The survey respondents were geographically dispersed across Canada, with Ontario accounting for the most respondents from any single area (almost 43% of the respondents). Fifty-six percent of the respondents had earned the Certified Health Executive designation, similar to the percentage of the total CCHSE member­ship with this designation. Men were significantly more likely than women to have earned this designation (X2 = 4.19, p = 0.04).

Perceived Importance of Factors Influencing the Demand for Pharmaceuticals

Table 1. Demographic Characteristics of Survey Respondents



Characteristic


No.

(%)

of
Respondents*


Sex
(n

= 272)


Male


123


(45.2)


Female


149


(54.8)



Years of experience

(n

= 267)


<5


17


(6.4)


6-10


39


(14.6)


11-15


46


(17.2)


> 16


165


(61.8)



Residence
(n
=
267)


British Columbia and Territories


38


(14.2)


Prairie provinces (Manitoba,
Saskatchewan, Alberta)


47


(17.6)


Ontario


114


(42.7)


Quebec


30


(11.2)


Atlantic provinces (Newfoundland and
Labrador,


Nova Scotia, New Brunswick, Prince
Edward Island)


38


(14.2)



Managerial position

(n

= 268)


Supervisor


1


(<1)


Manager


33


(12.3)


Director


85


(31.7)


Executive


120


(44.8)


Other


29


(10.8)


Work
settingt

(n

= 268)


Community hospital


72


(26.9)


Tertiary hospital


42


(15.7)


Long-term care facility


49


(18.3)


Regional health authority


68


(25.5)


Public third-party payer


2


(<1)


Private third-party payer


1


(<1)


Other*


75


(28.0)



Educational backgroundt

(n

= 268)


Bachelor’s degree


124


(46.3)


Master’s degree


193


(71.0)


MD


10


(3.7)


PhD


5


(1.9)


Other


40


(14.9)



Certified Health Executive

(n

= 266)


Yes


149


(56.0)


No


117


(44.0)


*Percentages are based on the number
of responses for each characteristic.


tRespondents could check any that
apply.


*The main types of work settings for
those who answered


“other” were academia,


government, consultancy, and the
military.

Changes in physician prescribing habits, introduction of innovative therapies, and changes in the use of existing medications were perceived as the 3 most important factors influencing the demand for pharmaceuticals (Table 2). Use of drugs in lieu of nondrug treatment, academic (counter) detailing, and direct-to-consumer advertising were perceived as the 3 least important factors influencing such demand.
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Table 2. Mean Rank of Factors Influencing Demand for Pharmaceuticals (n = 272 Respondents)



Influencing Factor


Mean
Rank* ± SD


Changes in physician prescribing
habits


3.0±2.2


Innovative therapies


3.7±2.4


Changes in the use of existing
medications


4.6±2.3


Changing health status of the
population


5.2±2.9


Increasing patient knowledge


5.4±2.3


Drug (pharmaceutical) representatives


5.6±3.0


Presence of new diseases to be treated


5.8±2.6


Use of drugs in lieu of nondrug
treatment


6.7±2.6


Academic (counter) detailing


6.8±2.8


Direct-to-consumer advertising


7.1±2.6


*Numeric ranking, where
1
=
most
important and


10 =
least
important.

Information SourcesNone of the 12 potential sources of information about pharmaceuticals and pharmaceutical policy listed in the survey were identified as “frequently used” by all respondents; however, for 7 of the 12 sources the mean score was 2.0 or higher (on a scale of 1 to 3, where 1 = not used at all and 3 = frequently used) (Table 3). The sources with the highest mean scores (indicating most frequent use), included the pharmacy department in the respondent’s organization, the Internet, and Health Canada. Voluntary health agencies, the Canadian Agency for Drugs and Technologies in Health, and the Cochrane Collaboration were used least frequently.
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Table 3. Mean Rank of Sources of Information for Pharmaceuticals and Pharmaceutical Policy (n = 272 Respondents)



Influencing Factor Mean Score* ± SD


Your organization’s pharmacy
department


2.6±0.75


Internet


2.2±0.76


Health Canada


2.1±0.73


Media


2.1±0.79


Medical literature


2.1±0.78


Pharmaceutical industry


2.0±0.77


Provincial health department


2.0±0.77


Canadian Institute for Health
Information


1.8±0.75


Benefit consultant or manager


1.5±0.65


Voluntary health agencies


1.5±0.64


Canadian Agency for Drugs and
Technologies


in Health


1.4±0.65


Cochrane Collaboration


1.4±0.66


*Scored by frequency of
use, where

3 =

frequently used and
1 =
not used at
all.

Perceived Importance of Methods to Optimize Pharmaceutical Use

From a list of 12 methods presented to respondents, clinical practice guidelines, disease management programs, and formulary management were perceived to be most important in optimizing the use of pharmaceuticals, whereas prior authorization, patient copayments, and tiered formularies were the least important (Table 4).
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Table 4. Perceived Importance of Methods of Optimizing Use of Pharmaceuticals



Method of Optimizing Use



Mean* ± SD


No.
of Responses


Clinical practice guidelines


4.4±0.71


225


Disease management programs


4.2±0.84


219


Formulary management


4.1±0.89


222


Generic substitution


4.0±0.96


222


Prospective drug utilization review


3.7±0.96


207


Retrospective drug utilization review


3.6±1.00


213


Pharmacoeconomic analysis


3.4±0.99


201


Wellness programs


3.2±1.20


208


Academic (counter) detailing


3.1±1.10


173


Prior (special) authorization


3.1±1.00


197


Patient copayments


2.9±1.10


209


Tiered formularies


2.9±1.00


163


*Scored by numeric
importance, where

5 =

very high importance and
1
=
very low
importance. Participants also had the option of a score of

6
(unable to assess),
but these data were not included in the analysis.

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