Research in Social and Administrative Pharmacy j (2014) j–j

Research Briefs

Pharmacists’ perspectives on the Patient Protection and Affordable Care Act Rahul Khanna, M.B.A., PhD.*, Rohan Mahabaleshwarkar, M.S., Erin R. Holmes, Pharm.D., Ph.D., Krutika Jariwala, M.S. Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi, University, MS 38677-1848, USA

Abstract Background: Passed in 2010, the Patient Protection and Affordable Care Act (PPACA) resulted in significant changes to the health care system in the United States (US). Though general population surveys reveal the fractious political debate surrounding the law, insights on pharmacists’ perspectives on the PPACA are lacking in the literature. Objectives: The objectives of this study were to determine pharmacists’ perspectives on the PPACA and determine whether pharmacists’ demographic and practice-related characteristics and political beliefs influence their perspectives on the PPACA. Methods: This study was conducted using a descriptive, cross-sectional design. Study data were collected with a self-administered online questionnaire distributed to 21,769 registered pharmacists in five states. Results: A total of 1127 completed surveys were received (5.6% response rate). Roughly 37% of pharmacists reported that they understood the major provisions of the PPACA although most (89%) respondents agreed that understanding such policies is important for practicing pharmacy. Just over half (50.6%) of respondents did not support the PPACA while 47.7% supported the legislation. Political orientation, age, gender, and race were found to be significantly related to pharmacists’ perspectives on the PPACA. Conclusion: Respondent pharmacists’ perceptions of the PPACA appear to be related to political orientation and demographic characteristics. Given that pharmacists will be impacted by the implementation of the PPACA and are so accessible to the public, additional information on health care policy and PPACA should be provided to pharmacists. Ó 2014 Elsevier Inc. All rights reserved. Keywords: Pharmacists; Patient Protection and Affordable Care Act; Health policy

Introduction Signed by President Barack Obama on March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) brought in the most

comprehensive changes to the American health care system since the creation of Medicare and Medicaid in 1965. Some of the key provisions of the PPACA include the creation of a new

* Corresponding author. Department of Pharmacy Administration, School of Pharmacy, Faser Hall Room 236, P.O. Box 1848, University, MS 38677, USA. Tel.: þ1 662 915 1651; fax: þ1 662 915 5102. E-mail address: [email protected] (R. Khanna). 1551-7411/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2014.04.003

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Patient’s Bill of Rights, support for the establishment of Accountable Care Organizations, expansion of Medicaid, private health insurance regulatory changes, establishment of a state and federal health insurance marketplace, incomebased subsidies for insurance access, and an individual mandate requiring insurance coverage for all individuals.1 Though it has been several years since its passage, PPACA remains a focal point of political discord. No other law in recent history has generated such passionate response across the political spectrum. According to an October 2013 Gallup poll of adults in the United States (US), 45% approve of the PPACA, while 50% disapprove of the law.2 The Gallup poll highlighted variation in attitude toward the law by party affiliation, with 86% of Republicans disapproving the law, and 83% of Democrats approving the law. As several provisions of the law are yet to be implemented, the overall impact of the law on the three essential barometers of health care system, i.e. cost, quality, and access, remains to be seen. Though surveys covering opinion of the general public on the PPACA appear on a regular basis, limited empirical studies describing the knowledge and opinion of health care professionals on PPACA exist. In one such study of medical students’ perspectives on the PPACA, Huntoon et al3 found that a large majority (w80%) of their participants supported the legislation. However, when asked of their opinion on the potential impact of the PPACA on health care cost, quality, and access, fragmented responses appeared. Roughly 31%, 68%, and 19% of their study participants believed that the PPACA will improve health care quality, increase access, and contain health care costs, respectively. Almost 59% of medical students did not favor the repeal of the PPACA. In a similar study with medical student participants, Winkelman et al4 found 46.5% supporting the legislation, with 12.5% not supporting the legislation. Less than half (48.8%) of the medical students reported understanding the basic components of the PPACA. A thorough review of the literature did not reveal any study describing pharmacists’ perspectives on the PPACA. Considering the direct and indirect influence of the PPACA on the pharmacy profession,5 it is essential to determine pharmacists’ perspectives on the PPACA. There are several provisions within the act that impact the practice of pharmacy, and thus necessitate

the knowledge of the act among members of the profession. For example, under the PPACA, Medicare ‘donut hole’ is to be eventually phased out by 2020. The PPACA includes provisions aimed at reducing costs and improving quality of care through integrated and collaborative care models, which embed pharmacists and pharmacy-related services.5 The PPACA builds on Medicare Modernization Act of 2003 by strengthening the requirement for medication therapy management (MTM) provision by Medicare Part D plans. The purpose of this study was to determine pharmacists’ perspectives on the PPACA and determine whether pharmacists’ demographic and practice-related characteristics and political beliefs influence their perspectives on the PPACA. Methods Study design and sample This study was conducted using a descriptive, cross-sectional design. Study data were collected with a self-administered online questionnaire distributed to pharmacists. A total of 21,769 registered pharmacists in a convenience sample of five states including Louisiana, Minnesota, Mississippi, Oregon, and Tennessee were targeted for study purposes. The email addresses of registered pharmacists in each of the five states were obtained from the respective pharmacy boards. The online survey was administered using the Qualtrics online survey software system (Qualtrics Inc., Provo, UT). The survey was conducted over a one month period (August 21–September 23, 2013), and included four reminder emails. Survey email included information about the study and a survey link. Further, the email emphasized voluntary participation and response confidentiality. The study was approved under exempt status by the University of Mississippi Institutional Review Board (UM IRB). Study questionnaire The questionnaire developed by Huntoon et al3 to measure medical students’ knowledge and attitude toward the PPACA was adapted by the investigators of this study for use in registered pharmacists. In this study, we modified the questionnaire to measure pharmacists’ perspectives on the PPACA. The study questionnaire included two sections. Section I included two subsections, with the first sub-section assessing pharmacists’

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perspectives on the PPACA, and the second subsection assessing their perspectives on health care reform advocacy and policy. Sub-section I (under Section I) included five items measured on a seven-point linear numeric scale from 1 (Strongly Disagree) to 7 (Strongly Agree). These items assessed pharmacists’ (self-reported) understanding of, and perspectives on, PPACA’s impact on health care cost, quality, and access. This sub-section also included three other multiple choice/true-false items assessing pharmacists’ support for the PPACA, support for repealing the PPACA, and the health care system that they favor. Sub-section II (under Section I) included four items assessing pharmacists’ perspectives on health care reform advocacy and policy. For all items measured in Section I that were scaled from 1 (Strongly Disagree) to 7 (Strongly Agree), a score greater than 4 was considered as “agreement,” score of 4 was considered “neutral,” and less than 4 was considered “disagreement.” Section II was designed to collect pharmacists’ demographic and practice-related characteristics, their political affiliation, their qualitative comments about the PPACA and its impact on the health care system. Data analysis Descriptive analysis on study variables was performed. Means (standard deviations) were calculated for continuous variables, and frequencies (percentages) were determined for categorical variables. Logistic regression analyses were performed to determine if pharmacists’ demographic and practice-related characteristics and political beliefs influenced their perspectives on the PPACA. In the first logistic regression model, the dependent variable of interest included pharmacists’ support (categorized as “support” versus “do not support”) for the PPACA. For the second model, a multinomial logistic regression model was fitted, with the dependent variable being pharmacists’ responses (“yes,” “no,” or “undecided) when asked if they support the repeal of the PPACA. Pharmacists’ political beliefs, demographic characteristics, and practice-related characteristics were included as independent variables in regression analyses. Odds ratio (OR) and corresponding confidence interval (CI) were reported. Study analyses were conducted using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY).

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Results Among the 1773 responses received, 1127 (5.6% response rate) were complete (less than 15% missing data) and were considered as the final sample and included for study analysis. Table 1 includes the demographic and practicerelated characteristics of the final sample of pharmacists. When comparing early responders (first 100 responders) to late responders (last 100 responders) on primary study variables using Student’s t-test or chi-square analysis, no significant differences on all except one item were found. For the item assessing pharmacists’ understanding of the major provisions of the PPACA, early responders were found to score higher than late responders (P ¼ .011). Table 2 describes pharmacists’ perspectives on the PPACA. Roughly 37% of pharmacists’ responded that they understood the major provisions of the PPACA, with w45% responding that they did not understand the major provisions. On being asked if they supported the repeal of the PPACA, 46% responded “yes” and 32.4% responded “no.” Additionally (not included in table), on being asked the type of health care system that they favor, roughly 23% answered the current health care system, 19% favored single-payer (Medicare for all), 12.7% favored private health insurance, and 29.1% reported being “not sure.” Table 3 describes pharmacists’ perspectives on health care reform advocacy and policy. Roughly 89% of pharmacists felt that an understanding of health systems and policy is important to practicing pharmacy. When asked if they participated in health care reform advocacy activities since the passage of the PPACA (not included in the table), 38.3% reported emailing legislators, 12.9% reported calling legislators, 27.7% reported signing a petition, 8.8% met with their legislator, 4.5% attended a rally, 9.2% attended a town hall meeting, and 2.7% submitted a “letter to the editor” or wrote an opinion editorial. Table 4 depicts the results from regression analyses. For the model predicting support for PPACA, political affiliation and race emerged as significant predictors. As compared to pharmacists who identified themselves as conservative, those who reported themselves as liberal had 27 times (CI 16.98–43.63) higher odds and those who reported themselves as centrist had about w7 times (CI 4.97–9.78) higher odds to support the PPACA. Political affiliation also emerged as

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Table 1 Characteristics of the study sample Characteristics

Pharmacists N (%)

Age, mean (SD) Gender Male Female Race White/Caucasian African American/Black Othera Political affiliation Very conservative Conservative Centrist Liberal Very liberal None Primary practice setting Chain community Independent community Hospital pharmacy Specialty pharmacy Otherb Pharmacy practice job title Owner/partner Staff/employee pharmacist Manager/director Otherc Number of years in practice, mean (SD) Highest degree BS in pharmacy PharmD MS in pharmacy PhD Other (MBA, etc.) Year graduated from last professional pharmacy degree, range Practice location Rural area Suburban area Urban area Number of hours worked per week, mean (SD) Had course or lecture devoted to the American health system and/or health policy during pharmacy degree program Yes No Totald

47.7 (13.3) 618 (50.8) 588 (48.3) 1083 (89.0) 45 (3.7) 79 (6.5) 82 541 239 222 41 83

(6.7) (44.5) (19.6) (18.2) (3.4) (6.8)

279 173 374 90 299

(22.9) (14.2) (30.7) (7.4) (24.6)

97 638 343 133 21.6

(8.0) (52.4) (28.2) (10.9) (13.8)

564 (46.3) 551 (45.3) 33 (2.7) 10 (0.8) 56 (4.6) 1949–2013 296 421 478 40.1

(24.3) (34.6) (39.3) (11.6)

279 (22.9) 933 (76.7) 1127 (100.0)

SD, standard deviation. a Other includes American Indian/Alaska native, Asian/Indian Asian, Native Hawaiian/Other Pacific Islander, Hispanic, and other race. b Other includes consultant, academia, pharmacy benefit manager, managed care, etc. c Other includes relief pharmacist, resident, faculty, consultant, and clinical pharmacist. d Sum within each sample characteristic may not add to 1217 because of missing data.

Table 2 Pharmacists’ perspectives on the Patient Protection and Affordable Care Act 1 ¼ Strongly Disagree

2

3

4

5

6

7 ¼ Strongly Agree

N (%)

N (%)

N (%)

N (%)

N (%)

N (%)

N (%)

198 (16.3)

178 (14.6)

169 (13.9)

223 (18.3)

250 (20.5)

134 (11.0)

64 (5.3)

3.66 (1.79)

45 (3.7)

49 (4.0)

79 (6.5)

135 (11.1)

212 (17.4)

225 (18.5)

472 (38.8)

5.45 (1.69)

3. The Patient Protection and Affordable Care Act (PPACA) will improve health care quality.

298 (24.5)

206 (16.9)

148 (12.2)

285 (23.4)

122 (10.0)

109 (9.0)

47 (3.9)

3.20 (1.78)

4. The Patient Protection and Affordable Care Act (PPACA) will expand access to health care.

195 (16.0)

111 (9.1)

130 (10.7)

227 (18.7)

199 (16.4)

222 (18.2)

129 (10.6)

4.08 (1.94)

5. The Patient Protection and Affordable Care Act (PPACA) will contain health care costs.

387 (31.8)

164 (13.5)

138 (11.3)

252 (20.7)

125 (10.3)

77 (6.3)

71 (5.8)

3.07 (1.88)

I support PPACA

I do not support PPACA

N (%)

N (%)

580 (47.7%)

616 (50.6%)

Statements

2. The American health care system as it exists today needs to be reformed.

6. Which statement best describes your attitude toward recent health care reform legislation?

5

(continued)

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1. I understand the major provisions of the health care reform law (Patient Protection and Affordable Care Act).

Mean (SD)

Khanna et al. / Research in Social and Administrative Pharmacy j (2014) 1–10

a significant predictor in the multinomial logistic regression analysis which included support toward repealing PPACA as the dependent variable. Also, pharmacists who classified themselves as liberal (OR ¼ 0.35, CI 0.22–0.55) or centrist (OR ¼ 0.10, CI 0.06–0.16) were less likely to be undecided (versus no) when asked if they supported the repeal of the PPACA as compared to pharmacists classified as conservative. Age, gender, and race also emerged as significant predictors in the model examining support toward repealing PPACA. For the open-ended question, several pharmacists expressed their opinion, with some supporting the PPACA, and others expressing their concerns and doubts over its potential impact. One pharmacist wrote, “Law has good intentions, but it’s going to be the ability of the government to efficiently implement the law that will make or break the PPACA. I am very skeptical that the government will be able to efficiently implement it without it costing the taxpayers.” Another pharmacist wrote, “It is not perfect, but it is a start” and another wrote, “This is a huge piece of legislation that will require some further changes and fine tuning. I think it is valuable and a step in the right direction, and I hope that the two parties can step away from the sound bite politics to actually work it and massage it into a piece of excellent legislation.” Some pharmacists expressed their opinion of the health care system in general, and pharmacy involvement in health policy. As mentioned by a pharmacist, “It is susceptible to abuse, we really need a single payer system similar to what Canada has.” Several pharmacists mentioned having limited understanding of the law. As one pharmacist said, “I want to learn more and every pharmacist I have asked about PPACA knows less than I do about this important topic.” Another said, “Wish I knew more. Wish there were continuing education opportunities to learn more.”

N (%)

Discussion SD, standard deviation.

394 (32.4%) 560 (46.0%) 7. Do you support repeal of health care reform law (Patient Protection and Affordable Care Act)?

Undecided

N (%) N (%)

N (%)

No Yes

260 (21.4%)

6

N (%) N (%)

5 4

N (%) N (%) N (%)

3 2 1 ¼ Strongly Disagree Statements

Table 2(continued )

N (%)

7 ¼ Strongly Agree

Mean (SD)

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Nearly 45% of pharmacists who participated in the study reported that they did not understand the major provisions of the PPACA. Similar sentiment was observed in the openended question, wherein several pharmacists expressed a lack of understanding of the PPACA, and need for continuing education programs focused on health care reform. In their study of medical students’ (all professional years) perspectives of the PPACA, Huntoon et al3 found

4.02 (1.69) 122 (10.0) 136 (11.2) 193 (15.9) 289 (23.7)

SD, standard deviation.

172 (14.1) 81 (6.7)

219 (18.0)

5.30 (1.43) 309 (25.4) 274 (22.5) 277 (22.8) 237 (19.5) 66 (5.4) 31 (2.5) 18 (1.5)

N (%)

499 (41.0) 350 (28.8)

N (%) N (%)

230 (18.9) 86 (7.1)

N (%) N (%)

22 (1.8) 13 (1.1)

N (%) N (%)

10 (0.8)

Understanding health systems and policy is important to practicing pharmacy. I believe it is my professional responsibility to participate in the health care policy-making process. I believe my experience as a pharmacist has provided me with sufficient health policy training.

2 1 ¼ Strongly Disagree Statements

Table 3 Pharmacists’ perspectives on healthcare reform advocacy and policy

3

4

5

6

7 ¼ Strongly Agree

Mean (SD)

5.94 (1.19)

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w30% reporting a lack of understanding of the law’s major provisions. As health care professionals, pharmacists are generally considered to be the most accessible to community patients, which necessitates their familiarity with the law’s major provisions. States pharmacy boards and educators should consider designing and implementing PPACA based continuing education programs that familiarize pharmacists of the law’s major provisions. On being asked if the PPACA will improve health care quality and contain costs, a majority disagreed. More than half of the pharmacists do not believe that the PPACA will improve health care quality and contain costs. In the study by Huntoon et al,3 20.9% and 36.0% of medical students disagreed that the PPACA will improve health care quality and contain costs. Given its broad scope, the PPACA does include strategies to improve health care quality and contain costs; however, there are uncertainties as to whether the law will be successful in achieving these objectives.6,7 When asked if the PPACA will expand health care access, a mixed response was observed among pharmacists with 45.2% agreeing and 35.8% disagreeing with the statement. Two of the major provisions of the PPACA include Medicaid expansion and establishment of state and federal health insurance marketplace. Just recently implemented, these provisions are intended to improve insurance access among the poor and uninsured. With the Supreme Court decision to give states the prerogative to choose Medicaid expansion,8 some states (26 as of December 2013) have considered, while others (25 states) have opted against expansion.9 It is too early to know the actual enrollment through these access provisions, but the proportion of population uninsured is expected to decrease. This may explain the generally positive sentiment toward the PPACA among pharmacists with respect to its impact on health care access. Despite the differing perspectives, a large proportion (w75%) of pharmacists did agree that the American health care system in its current state needs to be reformed. In terms of pharmacists’ perspectives toward health care reform advocacy and policy, a large majority (w89%) felt that an understanding of health systems and policy is important to pharmacy practice. Similarly, w71% believed participation in health care policy making process as a professional responsibility. As a profession, pharmacy has evolved significantly over the decades

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Table 4 Predictors of pharmacists’ perspectives on the Patient Protection and Affordable Care Act Characteristics

Odds ratio for support of PPACA

Odds ratio for support toward repealing PPACA

Odds ratio 95% CI

Yes versus No

Undecided versus No

Odds ratio 95% CI

Odds ratio 95% CI

Political affiliation Liberal 27.22 (16.98–43.63)*** 0.10 (0.06–0.15)*** Centrist/none 6.97 (4.97–9.78)*** 0.02 (0.01–0.03)*** Conservative Reference Reference Age, mean (SD) 1.00 (0.96–1.03) 0.97 (0.94–1.01) Gender Female 1.30 (0.93–1.80) 0.91 (0.62–1.33) Male Reference Reference Race African American/Black 6.68 (2.1–21.24)*** 0.14 (0.04–0.56)** Othera 1.23 (0.68–2.22) 1.51 (0.75–3.04) White/Caucasian Reference Reference Primary practice setting Independent community 0.59 (0.33–1.06) 1.22 (0.61–2.45) Hospital pharmacy 1.15 (0.75–1.77) 0.58 (0.35–0.97) Specialty pharmacy 0.63 (0.32–1.21) 0.59 (0.28–1.25) Otherb 1.41 (0.87–2.28) 0.62 (0.35–1.09) Chain community Reference Reference Pharmacy practice job title Staff/employee 1.45 (0.71–2.97) 0.55 (0.24–1.26) pharmacist Manager/director 1.82 (0.88–3.75) 0.56 (0.24–1.30) Otherc 1.69 (0.73–3.90) 0.38 (0.15–1.00) Owner/partner Reference Reference Number of years in 1.01 (0.98–1.05) 1.00 (0.97–1.04) practice, mean (SD) Highest degree PharmD 1.21 (0.78–1.88) 0.72 (0.43–1.20) MS in pharmacy 1.25 (0.52–3.00) 0.48 (0.18–1.26) PhD 3.90 (0.38–40.28) 0.52 (0.05–5.15) Other (MBA, etc.) 1.18 (0.54–2.33) 0.48 (0.21–1.07) BS in pharmacy Reference Practice location Suburban area 0.99 (0.66–1.48) 0.99 (0.62–1.60) Urban area 1.14 (0.75–1.71) 1.05 (0.65–1.69) Rural area Reference Reference Number of hours worked 1.00 (0.98–1.01) 1.00 (0.99–1.02) per week, mean (SD) Had course or lecture devoted to the American health system and/or health policy during No 0.95 (0.65–1.39) 1.17 (0.76–1.80) Yes Reference Reference

0.35 0.10 Reference 0.96

(0.22–0.55)*** (0.06–0.16)***

1.52 Reference

(1.02–2.25)*

0.93 1.53 Reference

(0.42–2.10) (0.76–3.10)

1.37 0.67 0.78 0.59 Reference

(0.66–2.83) (0.40–1.12) (0.36–1.69) (0.33–1.07)

0.95

(0.36–2.48)

1.00 0.92 Reference 1.01

(0.38–2.63) (0.31–2.72)

0.84 0.52 0.79 0.39 Reference

(0.48–1.47) (0.15–1.74) (0.08–7.58) (0.14–1.10)

0.91 0.89 Reference 1.01

(0.55–1.50) (0.54–1.46)

(0.92–0.99)*

(0.97–1.05)

(0.99–1.03)

pharmacy degree program 1.50 (0.96–2.34) Reference

CI, confidence interval. *P ! .05. **P ! .01. ***P ! .001. a Other includes American Indian/Alaska native, Asian/Indian Asian, Native Hawaiian/Other Pacific Islander, Hispanic, and other race. b Other includes consultant, academia, pharmacy benefit manager, managed care, etc. c Other includes relief pharmacist, resident, faculty, consultant, and clinical pharmacist.

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from drug dispensing to the provision of pharmaceutical care. With the widening of their professional responsibilities and their community placement, the involvement of pharmacists in health care policy decision-making may contribute toward program success. When asked about their participation in health care reform advocacy over the past three years, w38% said that they emailed their legislators, 13% called legislators, 28% signed a petition, and several attended a rally, town hall meeting, or met with their legislators. It was encouraging that a majority of pharmacists surveyed in this study felt a professional need for participation in health care policy making. However, only about 37% felt that their experience as a pharmacist provided them with sufficient health policy training. By making health systems and policy training a core part of curriculum, pharmacy schools can help bridge this educational and training gap. Just more than half of the pharmacists in the current study did not support the PPACA, while w48% supported the PPACA. In contrast, approximately 80% of medical students in the study by Huntoon et al3 supported the PPACA. Results of this pharmacist study mirror those from a recent Gallup poll which found 50% American adults disapproving and 45% approving the law.2 Further, 46% of pharmacists supported and 32.4% opposed to repealing the PPACA. In the study by Huntoon et al,3 15% supported and approximately 59% were opposed to repealing the PPACA. When examining the role of demographic characteristics, practicerelated characteristics and political beliefs in influencing pharmacists’ view of the PPACA, significant findings emerged. Political orientation was found to play a major role in influencing pharmacists’ perspectives on the PPACA. Pharmacists who reported themselves as liberal or centrists were more likely to have a favorable view of the law, and were less likely to support its repeal. Given the current political climate, these results are not surprising. Age, gender and race also emerged as significant predictors of pharmacists’ perspectives on the PPACA. African American/ Black pharmacists were more likely to support the PPACA, and less likely to support the repeal of the law as compared to White/Caucasian pharmacists. In a survey of adults conducted (September 4–8, 2013) by Pew Research Center and USA TODAY, 91% of Blacks supported the PPACA, while 29% of White supported the law.10 The current study results, together with

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those from surveys of the general adult population, highlight a racial variation in support for the PPACA. Study limitations The primary limitation of this study is its low response rate (5.6%). The low response rate observed could be due to lack of incentives11 and the general nature of online surveys, which have been shown to have a lower response rate than postal surveys.12 The sensitivity and political nature of the topic could also have prevented some pharmacists from participating in the survey. Additionally, only pharmacists registered in a convenience sample of five states were surveyed. Together, these factors may have contributed toward limiting the generalizability of our study results. It should also be noted that self-reported understanding of the PPACA as captured in this study may not be reflective of an in-depth understanding of the law among pharmacists. Further research assessing pharmacists’ knowledge of the specific components of the PPACA is needed. However, with no prior study in this area, we believe that this study contributes significantly to the literature, and provides a glimpse of pharmacists’ perspectives on a major legislation affecting the health care arena. Conclusion Pharmacists responding to the survey reported a limited understanding of the PPACA major provisions, highlighting the need for health care reform education among pharmacists. Similar to views reflected in general public polls, limited support for the PPACA as found among pharmacists participating in this study. While 47% of pharmacists surveyed supported the law, more than half had an unfavorable opinion. Though pharmacists believed participation in health care decision making to be their professional responsibility, they felt lacking sufficient health policy training. State boards of pharmacy, professional pharmacy associations and schools of pharmacy should consider implementing health care reform education and continuing education programs to serve the training needs reflected among surveyed pharmacists. Acknowledgments We are grateful to Dr. Paul Gorman and his colleagues for sharing their study survey, and giving us the permission to use for our study.

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We would also like to acknowledge our study participants for their time and effort in completing the survey.

6.

References

7.

1. U.S. Department of Health and Human Services. Key Features of the Affordable Care Act by Year. Available at: http://www.hhs.gov/healthcare/facts/ timeline/timeline-text.html#2012; Accessed 02.01.14. 2. Gallup. Approval of Affordable Care Act Inches Up. Available at: http://www.gallup.com/poll/165548/ approval-affordable-care-act-inches.aspx; Accessed 03.01.14. 3. Huntoon KM, McCluney CJ, Scannell CA, et al. Healthcare reform and the next generation: United States medical student attitudes toward the Patient Protection and Affordable Care Act. PLoS One 2011;6:e23557. 4. Winkelman TN, Antiel RM, Davey CS, Tilburt JC, Song JY. Medical students and the Affordable Care Act: uninformed and undecided. Arch Intern Med 2012;172:1603–1605. 5. American Pharmacists Association. Healthcare Reform – Implementation of the Affordable Care Act. Available at: http://www.pharmacist.com/

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Pharmacists' perspectives on the Patient Protection and Affordable Care Act.

Passed in 2010, the Patient Protection and Affordable Care Act (PPACA) resulted in significant changes to the health care system in the United States ...
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