Pharmacoeconomics and outcomes research degree-granting PhD programs in the United States

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1 Research in Social and Administrative Pharmacy 9 (2013) Research Briefs Pharmacoeconomics and outcomes research degree-granting PhD programs in the United States Julia F. Slejko, Ph.D.*, Anne M. Libby, Ph.D., Kavita V. Nair, Ph.D., Robert J. Valuck, Ph.D., R.Ph., Jonathan D. Campbell, Ph.D. Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes Research (CePOR), University of Colorado Aschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Abstract Background: Evidence is missing on showcasing current practices of degree programs specific to the field of pharmaceutical outcomes research. Objectives: To measure current practices of pharmacoeconomics and outcomes research PhD programs in the United States and synthesize recommendations for improving the success of programs and prospective students. Methods: A 23-question online survey instrument was created and distributed to 32 program directors identified in the International Society for Pharmacoeconomics and Outcomes Research educational directory. Descriptive statistics summarized both the program characteristics (including observed and desired number of faculty and students) and training recommendations (traits of program and student success). Results: Of 30 eligible programs that conferred a PhD in pharmacoeconomics, pharmaceutical outcomes research, or a related field, 16 respondents (53%) completed the survey. Seventy-five percent of respondents were located in a school of pharmacy. The average observed number of faculty (7.5) and students (11.5) was lower than the average desired numbers (8.1) and (14.7), respectively. Reputation of faculty research and a collaborative environment with other disciplines were rated highest for a program s success. Faculty s mentoring experience and reputation and student funding opportunities were rated highest for prospective students success. Conclusions: Existing and emerging programs as well as prospective students can use these findings to further their chances of success. Ó 2013 Elsevier Inc. All rights reserved. Keywords: Outcomes research; Pharmacoeconomics; Graduate training; Education; PhD programs Introduction Outcomes research is an applied discipline of the relationship between health care interventions and patient outcomes, spanning clinical, humanistic, and economic outcomes. 1 Outcomes research, by its definition, is multidisciplinary. * Corresponding author. University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, E. Montview Blvd., Room V , Aurora, CO 80045, USA. Tel.: þ ; fax: þ address: julia.slejko@alumni.colorado.edu (J.F. Slejko) /$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. doi: /j.sapharm

2 Slejko et al. / Research in Social and Administrative Pharmacy 9 (2013) In regard to pharmaceutical outcomes research in particular, study design and methods include epidemiology and pharmacoepidemiology; economics and health economics; health or drug policy; public health; and other social and administrative sciences as they relate to health care. Pharmacoeconomics is a discipline related to outcomes research focusing on health technology assessment and aims to evaluate clinical, economic, and humanistic aspects of pharmaceutical interventions that can aid efficient allocation of health care resources. 1 Training programs in outcomes research and pharmacoeconomics may be identified through a number of sources. The American Association of Colleges of Pharmacy provides a listing of economic, social, and administrative sciences PhD programs on its Web site. 2 While this lists programs within schools of pharmacy, programs outside pharmacy schools also exist, such as many of those listed in the educational directory of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Web site. 3 Several studies have investigated the growth and status of pharmacoeconomic and/or outcomes research education in the United States. A study published in 2000 surveyed U.S. institutions of pharmacy and found that 26 PhD programs in pharmacoeconomics and outcomes research existed, with 136 full-time students enrolled, an increase since a previous 1994 survey. 4,5 Farley et al 6 investigated the funding of economic, social, and administrative sciences PhD training in U.S. pharmacy institutions. This study reported that 91% of programs guarantee funding to incoming students and 85% of these students graduate from the program. Rascati et al 7 described a need for pharmacoeconomic education as well as a need for published information about pharmacoeconomic education existing outside of pharmacy schools. The aforementioned studies described the growth of training programs within schools of pharmacy. However, no known studies have used the ISPOR educational directory as a population of inference; ISPOR is the prominent society in pharmacoeconomics and outcomes research and contains programs both within and outside of schools of pharmacy. The study objective was to measure current practices of pharmacoeconomics and outcomes research PhD programs in the United States and synthesize recommendations for improving the success of programs and prospective students from the perspective of program directors. Methods Study population The study population was identified from the 32 U.S. degree programs listed in the educational directory of the ISPOR Web site 3 (12/09). Programs were included if the respondent affirmed that the program conferred a PhD in pharmacoeconomics, pharmaceutical outcomes research (a definition was provided 1 ), or a related field. Survey outcome measures, design, and implementation The survey outcome measures were characteristics of PhD programs and their faculty and students, as well as their rating of attributes important to the quality and success of PhD programs and of PhD student training in this field. Outcome measures of the survey included location of the program, differences in the time the program had existed, core training areas, students previous education, counts of faculty, and students career sectors postgraduation. Questions were also asked about the number of students who were currently enrolled, ever enrolled, completed, or opted not to complete the program. A focus of the study was to assess the values regarding components important for a program s success and consideration by future students. The survey asked what attributes of a pharmacoeconomics or outcomes research PhD program are most important for its success and quality and also what attributes should be considered by students before entering a program from the perspective of the program director. The 23-question survey instrument was designed and implemented using Zoomerang (MarketTools, San Francisco, CA). 8 Most survey items used drop-down boxes or lists of choices to decrease respondent burden. Two questions regarding characteristics important to PhD programs were presented. The first asked what attributes of a program are most important for its success and quality. The second asked what attributes should be considered by students before entering a program. For each of these questions, 6 attributes were listed with a corresponding 10-point scale, where 1 represented not important and 10 represented essential. Respondents rated each attribute on the 10-point scale. The survey was implemented by invitation to the individual listed on the ISPOR Web site for each of the 32 programs. In some cases, this individual forwarded the invitation or redirected

3 110 Slejko et al. / Research in Social and Administrative Pharmacy 9 (2013) the authors to another individual. Their participation in the online survey was requested if they responded that they offered a PhD program focused on pharmacoeconomics, outcomes research, or related fields. The initial survey invitation was ed to study subjects in December Reminder s were sent to those who did not respond after 3 and 6 weeks. The study was closed for participation after 8 weeks from the initial request for participation. The survey content and implementation was validated and pilot tested by a group of faculty at the University of Colorado. This research was considered exempt by the Colorado Multiple Institutional Review Board. Analysis Descriptive statistics were used to summarize respondent data using SAS version 9.2 (SAS Institute Inc., Cary, NC) and STATA IC/10.0 (StataCorp LP, College Station, TX). 9,10 Because the study was exploratory in nature, proportions and means were used widely to describe program characteristics. Some survey items queried respondents to report the proportion of students who had attained varying levels of education or proportions of graduates obtaining employment in different sectors. To summarize these findings, the mean proportion across programs was estimated and reported. Means were estimated to describe time in years, number of students, and number of faculty. Student-to-faculty ratios were computed using these measures. The observed and desired number of students, faculty, and studentto-faculty ratios were compared using a Student t test. Means and 95% confidence intervals were generated and plotted to illustrate the program attribute ratings and associated ranges. Results Of the 32 unique programs contacted, personnel from 22 (69%) programs responded, with 2 stating that their program did not fit the inclusion criteria. Of the 30 eligible programs, 16 respondents (53%) fully completed the online survey instrument. Overall program attributes Most programs (12 of 16 or 75%) were located in a school of pharmacy (Table 1). The other 4 programs were housed in schools of business, public health, or graduate studies (referred to here as other schools). Core areas of training included 63% for Range Mean, Table 1 Observed and desired average number of faculty and students in PhD programs Measure Mean, Range observed a desired a Full-time faculty Overall PhD students Overall Student-to-faculty ratio Overall a Differences were not statistically significant. pharmacoeconomics, 25% for pharmacoepidemiology, and 44% for health policy (Table 2). Nine programs typed additional areas of emphases in their survey response including social and behavioral sciences, drug utilization, patient safety, and marketing. Programs reported that on average, Table 2 Characteristics of PhD programs and students Characteristic N ¼ 16 (100%) Location of PhD program N(%) within the university School of pharmacy 12 (75) Other school (business, 4 (25) graduate, and public health) Core areas of study a N(%) Pharmacoeconomics 10 (63) Pharmacoepidemiology 4 (25) Health policy 7 (44) Previous education of PhD Mean proportion (%) students Professional training 35 Graduate training 50 Undergraduate degree only 15 Time in years to Mean (SD), range Coursework completion 2.6 (0.72), 2-4 Graduation 4.9 (1.1), 4-7 Number of students who Mean (SD), range Have entered the program 24.3 (10.5), 5-41 since its establishment Have completed the program 17.5 (10.7), 0-30 Have chosen not to complete 3.7 (3.3), 0-10 the program SD, standard deviation. a Programs were allowed to list more than 1 core area of study; therefore, percentages will not add to 100%. Programs were allowed to write in additional core areas of study.

4 Slejko et al. / Research in Social and Administrative Pharmacy 9 (2013) % of students had some type of graduate training before entering a PhD program, with 35% having professional training (PharmD, MD, JD, MBA, etc) and 50% having another type of master s degree (MS, MA, MPH, etc) (Table 2). The mean time to completion of coursework was 2.6 years, and time to graduation was 4.9 years across all programs. Of those students who had ever entered the PhD programs surveyed, on average, 15% of students opted not to complete the degree. The mean number of full-time faculty for PhD programs was 7.5, whereas the desired number of faculty was 8.1. The mean number of current students was 11.5, whereas the desired number was This resulted in an observed student-to-faculty ratio of 1.5 and a desired ratio of 1.7 (Table 1). These differences were not statistically significant. Across all programs, on average, 35% of graduates took their first position in academia (including postdoctoral training), 35% in industry, 11% in other research organizations, 11% took consulting positions, and the remaining 8% were in another sector or unknown (data not shown). The proportion of alumni in each sector for their current job was similar to the proportions for the first job after graduation (data not shown). Valuable attributes for program and student success When asked about valuable attributes for the success of the training program, reputation of faculty research and a collaborative environment with other health science disciplines were the attributes rated most highly, whereas diverse research interests of faculty and alumni involvement were rated lowest (Fig. 1). Nine of 12 schools of pharmacy used text fields to describe other attributes important to the success and quality of the program, including Support from chair, dean, and/or administration Number of graduate students, faculty, and ratio Research infrastructure, database availability Interaction with other university departments for coursework and/or collaboration When asked about attributes important for students success, faculty s mentoring experience and reputation and student funding opportunities were rated highest, whereas the student-to-faculty ratio and time to graduation were rated lowest (Fig. 2). Once again, only schools of pharmacy submitted additional attributes. They included Fig. 1. Program attributes most important for its success and quality on a 10-point scale, where 1 represented not important and 10 represented essential. CI, confidence interval. Faculty research quantity and quality Faculty publication reputation History of program to graduate students Current employment of alumni Discussion Educating outcomes researchers is a priority of the ISPOR Vision 2020, 11 and understanding the status of training in the field may help guide future Fig. 2. Program attributes to be considered by students before entering a program on a 10-point scale, where 1 represented not important and 10 represented essential. CI, confidence interval.

5 112 Slejko et al. / Research in Social and Administrative Pharmacy 9 (2013) educational efforts. A first step is locating where training takes place by querying programs both within and outside schools of pharmacy. This study found that outcomes research training is offered in both locations. Further research may study how training differs between these settings. The growth of the pharmacoeconomics discipline is illustrated in part by the steady increase of published costeffectiveness analyses over time. 12,13 Pharmacoeconomic training exists within PharmD programs 14,15 and as an area of emphasis in PhD training. This study added to the existing literature by summarizing program directors opinions on characteristics of a successful PhD program, as well as those characteristics important for prospective students to consider. There was a strong theme of faculty quality as a determinant of a program s success as well as an important consideration for future students. Overall, this study found that programs appear to value the reputation of faculty s research as well as a collaborative environment with other scientific disciplines as factors in a program s success. Program director respondents recommended that prospective students consider the faculty s research and involvement and faculty s mentoring and funding opportunities. This study has limitations. The objective of the study was exploratory, and the survey instrument did not undergo extensive validity and reliability testing. However, pilot testing of the survey was performed by a group of faculty at the University of Colorado, and the survey was modified based on the pilot test recommendations. It should be noted that only one person in each program was surveyed and different personnel at a single program may respond differently to the survey questions. The study sample was limited to PhD programs identified by the ISPOR Web site educational directory. Other PhD programs in this field exist but were not included in the directory and therefore not surveyed. Future research may aim to create a more comprehensive listing of outcomes research training programs, based on educational directories maintained by several societies or associations. The 53% completion rate in our study is considered to be above average for an Internet survey. 16 However, the sample size itself (16) is small and limits the study to be exploratory and indicative of trends. Furthermore, our ability to compare across programs within the university was limited by a small sample size (4 programs outside schools of pharmacy responded). The program directors perspective was elicited in the survey instrument; however, their opinion may not be representative of all perspectives in the program. Existing and emerging programs as well as prospective students can use these findings to further their chances of success. Growth of the fields of pharmacoeconomics and outcomes research is signaled by the study finding that training programs have a desire for expansion in terms of both faculty and students. The next generation of researchers in this field should look for training programs with faculty who have strong mentoring and good funding opportunities for students. As programs grow to accommodate these students, their faculty s research reputation and a collaborative research environment are valuable attributes for their success. Acknowledgments The authors thank the PhD programs personnel who participated in the survey research. J.D.C. is a K12 Scholar in Comparative Effectiveness Research funded by the Agency for Healthcare Research and Quality. References 1. Berger M, Bingefors K, Hedblom E, Pashos C, Torrance G. Health Care Cost, Quality, and Outcomes: ISPOR Book of Terms. Lawrenceville, NJ: ISPOR; Graduate degree programs anticipated for , American Association of Colleges of Pharmacy. Available at: graduateresearchstudents/pages/graduatedegreepro grams aspx. Accessed ISPOR educational directory, International Society for Pharmacoeconomics and Outcomes Research. Available at: US.asp. Accessed Jackson T, Draugalis J. Graduate pharmacoeconomic and outcomes research educational programs in colleges and schools of pharmacy: a five-year update. Am J Pharm Educ 2000;64: Gregor KJ, Draugalis JR. Graduate pharmacoeconomic education and training-programs in us colleges of pharmacy. Am J Pharm Educ 1994;58: Farley JF, Wang CC, Blalock SJ. The Status of PhD Education in Economic, Social, and Administrative Sciences Between 2005 and Am J Pharm Educ 2010;74:7. 7. Rascati KL, Drummond MF, Annemans L, Davey PG. Education in pharmacoeconomics - An international multidisciplinary view. Pharmacoeconomics 2004;22: Zoomerang [computer program]. San Francisco, CA: Zoomerang, a MarketTools Company, 2011.

6 Slejko et al. / Research in Social and Administrative Pharmacy 9 (2013) STATA IC/10.0 [computer program]. College Station, TX: StataCorp LP, SAS Version 9.2 [computer program]. Cary, NC: SAS Institute Inc, ISPOR Vision 2020, International Society for Pharmacoeconomics and Outcomes Research. Available at: Accessed Neumann PJ, Greenberg D, Olchanski NV, et al. Growth and quality of the cost-utility literature, Value Health 2005;8: Greenberg D, Rosen AB, Wacht O, et al. A bibliometric review of cost-effectiveness analyses in the economic and medical literature: Med Decis Making 2010;30: Reddy M, Rascati K, Wahawisan J, Rascati M. Pharmacoeconomic education in US colleges and schools of pharmacy: an update. Am J Pharm Educ 2008;72. Article Rascati KL, Conner TM, Draugalis JR. Pharmacoeconomic education in US schools of pharmacy. Am J Pharm Educ 1998;62: Cook C, Heath F, Thompson RL. A meta-analysis of response rates in web- or internet-based surveys. Educ Psych Measure 2000;60: