title: Evaluation of an educational program on deciphering heterogeneity for medical coverage decisions.
abstract: BACKGROUND
  It is increasingly important for decision makers, such as medical and pharmacy managers (or pharmacy therapeutics committee members and staff), to understand the variation and diversity in treatment response as decisions shift from an individual patient perspective to optimizing care for populations of patients.
  
  
  OBJECTIVE
  To assess the effectiveness of an instructional program on heterogeneity designed for medical and pharmacy managers.
  
  
  METHODS
  A live educational program was offered to members of the Academy of Managed Care Pharmacy at the fall 2012 educational meeting and also to medical directors and managers attending a national payer roundtable meeting in October 2012. Participants completed a retrospective pretest-posttest assessment of their knowledge, attitudes, and self-efficacy immediately following the program. Participants were offered the opportunity to participate in a follow-up assessment 6 months later. Willing participants for the follow-up assessment were contacted via e-mail and telephone. Rasch rating scale models were used to compare pre- and postscores measuring participants' knowledge about and attitude towards heterogeneity.
  
  
  RESULTS
  A total of 49 individuals completed the retrospective pretest-posttest assessment and agreed to be a part of the program evaluation. Fifty percent (n = 25) of participants had heard of the phrase "heterogeneity of treatment effect," and 36 (72%) were familiar with the phrase "individualized treatment effect" prior to the live program. Participants reported a significant improvement in knowledge of heterogeneity (P  less than  0.01) and attitudes about heterogeneity (P  less than  0.01) immediately after attending the program. At the time of the educational program, participants had either never considered heterogeneity (26%) or reported not knowing (28%) whether their organizations considered it when determining basic coverage. Participants were more likely to report "sometimes" considering heterogeneity for determining necessity for individual appeals, prior authorization, tier placement for pharmaceutical therapies, and other types of medical management. At the 6-month follow-up, 21 of the 49 willing participants (43% response rate) completed the evaluation; participants continued to have a good understanding of heterogeneity, but there was no significant difference in attitudes towards heterogeneity between pre- and 6-month follow-up.
  
  
  CONCLUSIONS
  A live educational program was effective in improving participants' immediate knowledge and attitudes regarding the topic of heterogeneity. Participating managed care pharmacists and medical managers indicated that heterogeneity of treatment effect was likely to be used in determining prior authorizations and determining necessity.
authors.affiliation: The University of Arizona, 1295 N. Martin, P.O. Box 210202, Tucson, AZ 85721. malone@pharmacy.arizona.edu.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Warholak
authors.forename: Jianhua W
authors.initials: JW
authors.lastname: Hilgaertner
authors.forename: Joni L
authors.initials: JL
authors.lastname: Dean
authors.forename: Ann M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Hines
authors.forename: Jason
authors.initials: J
authors.lastname: Hurwitz
authors.forename: Mary
authors.initials: M
authors.lastname: Brown
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Malone
mesh_terms: D001291:Attitude of Health Personnel; D016527:Drug Costs; D004513:Education, Pharmacy, Continuing; D005569:Formularies as Topic; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D007342:Insurance Benefits; D019458:Insurance Coverage; D007356:Insurance, Pharmaceutical Services; D008329:Managed Care Programs; D018579:Patient Selection; D010593:Pharmaceutical Services; D011050:Policy Making; D044382:Population Groups; D055553:Prescription Drugs / Q000627:therapeutic use*; D015397:Program Evaluation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D055553:Prescription Drugs