Pharmacoeconomics Examination III Page: 1 of 1

Name:_______________________________

Pharmacoeconomics and Health Outcomes

Spring 2000

Examination III

Instructions:
1. Please complete the computer answer sheet, with BOTH your name and student ID.

2. Please endorse the honor code. You should write either of the following statements:
“Submitted with honor” or “I have neither given nor received unauthorized aid
on this exam, nor have I witnessed anyone doing so.” in the space below and
sign your name. Thank you.

Honor Code:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________
Pharmacoeconomics Examination III Page: 2 of 2

Name: ______________________________________

Read each question carefully, and select the most correct answer. Good luck!
Please read the attached study from the Archives of Internal Medicine, Vol 159, 4/26/99, pp 857+. The 15 questions
below are based on this manuscript. The first 5 questions ask about how well this manuscript meets the criteria for a
well-written research report. Remember to base your answers on only the material presented in the article.

A 1. The study objectives are clearly stated.

A 2. The HRQoL instrument(s) used in the study are described for the readers. A. True

A 3. The characteristics of the subjects, and how they were selected, are described.

A 4. The statistical analyses used were described for the readers. B. False

A 5. The conclusions are discussed, along with the limitations of the study.

B 6. Patients were randomly assigned to participate in the study

A 7. In general, patients with migraines report lower quality of life than patients with
diabetes, hypertension, or depression.

B 8. This study was conducted in a “mixed-model” managed care organization (MCO). What does this term tell you
about the MCO’s structure?
A. all of the medical providers are staff employed only by the MCO.
B. this MCO has some providers directly employed, plus contracts with other independent groups of
providers.
C. this MCO exists only as a loose network of contracts between groups of providers.
D. this MCO uses an exclusive provider organization (EPO).
E. this MCO must contain an in-house pharmacy as well as contracting with one or more chain stores.

E 9. An advantage of using a general and a disease specific HRQoL survey instrument include:
A. the disease specific survey is more sensitive to measuring changes due to this therapeutic treatment
B. the general health survey is more sensitive to measuring changes due to this therapeutic treatment.
C. the disease specific survey provides for comparability across different groups of patients
D. the general health survey provides for comparability across different groups of patients
E. more than one of the above is correct.

B 10. The SF-36 results in this study indicate:

A. these migraine patients showed significant improvements above population norm values.
B. these migraine patients showed significant improvements over some of their baseline values.
C. these migraine patients were initially (statistically) significantly below population norm values on all SF-36
dimensions.
D. these migraine patients improved (statistically) significantly on all SF-36 dimensions over their baseline
values.
E. more than one of the above is correct.
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D 11. The authors report using “Disability Time” which uses all of the following work outcomes, except:
A. non-workplace days missed.
B. reduced effectiveness on non-workplace days while having a migraine.
C. workplace days missed.
D. the extent to which employers hired replacements.
E. reduced effectiveness on workplace days while having a migraine.

C 12. How were the changes in work outcomes measured in this study?
A. patients gave permission to have their employers contacted for their attendance records.
B. proxies were asked to assess how migraines affected the patient’s productivity.
C. patients were asked to remember this information and report it on a questionnaire.
D. differences were measured by examining a control group who were working.
E. the MSQ survey contains this information.

B 13. The authors report a “dramatic” increase in patient satisfaction with how well their migraine medication worked.
Which is the most likely reason the change was so dramatic?
A. the satisfaction survey had a serious “ceiling” or “floor” effect.
B. before sumatriptan, patients had very low expectations that medications could improve their migraines.
C. before sumatriptan, patients had very high expectations that medications could improve their migraines.
D. the effects depended on patient’s memory and were thus seriously flawed.
E. the satisfaction survey must have been valid but not reliable.

A 14. Compared to the “dramatic results” described above, if you measured changes in patient satisfaction between
sumatriptan and some newer 5HT1 receptor agonist, you would expect to see:
A. smaller improvements in satisfaction, because patient expectations will have been raised.
B. smaller improvements in satisfaction, because patient expectations will have been lowered.
C. larger improvements in satisfaction, because patient expectations will have been raised.
D. larger improvements in satisfaction, because patient expectations will have been lowered.
E. cannot be determined because there is no relationship between satisfaction and expectations.

C 15. One of the most serious limitations of this study is:

A. the random assignment of patients weakened the content validity of the results.
B. there was no input from the pharmaceutical industry in the design or completion of this study.
C. the non-random assignment of patients raises the possibility of confounding variables causing the
observed results.
D. the random assignment of patients weakened the generalizeability of the results.
E. the patients, who were non-randomly assigned, responded to HRQoL instruments with poor construct
validity and reliability.

A 16. Which of the following best describes our current definition of “health” ?
A. a state of complete physical, mental, and social well-being.
B. the point at which a patient can return to work.
C. the absence of disease or infirmity
D. any patient condition which corresponds to 100% work productivity
E. the absence of any psychological distress
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E 17. Our current concept of health can be broken down into which 4 dimensions:
A. births, deaths, marriages, and disabilities.
B. financial; technical; explanation; and consideration.
C. validity; reliability; sensitivity; and specificity.
D. physical health; mental health; social health; and disabilities.
E. physical health; mental health; social health; and general health perceptions.

D 18. The largest developer and user of disease-specific health surveys is:
A. the Food & Drug Administration (FDA) B. health care payers.
C. managed care organizations (MCOs). D. the pharmaceutical industry.
E. the Health Care Financing Administration (HCFA).

A 19. Which of the following terms is NOT equivalent to the term: “survey.”
A. profile B. questionnaire
C. instrument D. tool

B 20. If you needed to collect survey information about patients’ use of illegal drugs, which survey method would be
the most appropriate?
A. face-to-face interviews of the patients being surveyed
B. computer-assisted / computer interactive interviews
C. mail-back surveys
D. personal observation
E. face-to-face interviews of proxies for the patients being surveyed

B 21. Cronbach’s alpha is the statistic used to measure which survey characteristic?
A. convergent validity B. reliability
C. sensitivity D. precision

D 22. There have been several studies published which describe patient satisfaction with pharmacy services. Which
pharmacy practice setting has had the least amount of research in the area of patient satisfaction?
A. hospital outpatient pharmacy B. mail-order pharmacy
C. HMO in-house pharmacy D. hospital inpatient pharmacy

C 23. All of the following are reasons why are we interested in measuring work outcomes, except:
A. work outcomes are the basis of measuring indirect costs
B. work represents a large proportion of our waking hours
C. work represents a measure of met needs and wants
D. work is related to our psychological well being
E. work represents an important social interaction role

B 24. All of the following are key uses for work outcomes information, except:
A. provides information on the impact of chronic diseases.
B. provides the major proportion of direct cost information.
C. provides information to assess disability management and rehabilitation programs.
D. provides information to evaluate the effectiveness of local and national disability policies.
E. provides a basis for provider / purchaser / employee health improvement efforts.
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A 25. Cosler’s Pharmacy, Inc. has just hired a pharmacist who is hearing impaired. The pharmacist can complete
the same number of prescriptions per day as any of the other pharmacists, but requires some special
equipment to handle some of the other job duties. This pharmacist:
A. has difficulty with job performance, but good productivity.
B. has difficulty with productivity, but good job performance.
C. has a severe disability preventing their functioning as a pharmacist
D. has no limitations since they are working full time
E. more than one of the above is correct

For the questions below, select the correct scale of measurement.

A. Nominal
D 26. Asking patients the number of hours of sleep they average per night.
B. Ordinal
A 27. Asking patients to list the immunizations they have received. C. Interval
B 28. Asking patients to rank the days of the week according to their preference D. Ratio
for medical appointments. E. None of the above

D 29. Recording a patient’s weight in kilograms.

D 30. I’ve developed a survey that predicts whether students will “pass” or “fail” pharmacoeconomics. The table
below compares the results of my survey to actual final grades. (They’re not from your class!) What is the
specificity of my survey?
A. 0.9 B. 0.1 C. 0.3 D. 0.7 E. none of the above

Reality (based on Final Grades)

"Passed" "Failed"

"Passed" 144 12

Cosler's
Predictive
Survey

"Failed" 16 28

B 31. Patient’s perceptions of symptoms are based only on measurable clinical parameters.
A. True B. False

A 32. When measuring health utilities, patients can report values for some conditions as being worse than death.
A. True B. False

B 33. The SF-36 health survey is available in dozens of languages (including Russian). Reliability and validity
statistics for each version must be based only on the U.S. English version.
A. True B. False

D 34. The time and effort required for patients to complete a HRQoL survey is referred to as:
A. Respondent acquiescence B. Criterion Validity
C. Instrument cost D. Respondent burden
E. Psychometrics
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B 35. Which of the following statements is true?

A. A pre-test uses more patients than a pilot test
B. A pre-test is OK if using a previously tested “gold standard” survey
C. A pilot test is OK if using a previously tested “gold standard” survey
D. A pre-test is a full “dry run” of the survey procedures
E. None of the above statements is true

C 36. Which of the following is not a reason to measure quality (i.e. “performance”) in managed care settings?
A. There is too much variation in the use of expensive medical procedures.
B. Managed Care Organizations are trying to respond to a lot of negative criticism.
C. To prevent providers from “voting with their feet.”
D. Employers and payers are demanding high quality health care
E. All of the above are correct reasons.

B 37. The New York State performance standards for managed care organizations are referred to as:
A. National Committee for Quality Assurance (NCQA) standards
B. Quality Assurance Reporting Requirements (QARR)
C. Health Plan Employer Data Information Set (HEDIS) standards
D. Healthy People 2010 Goals.
E. Best Estimated Employer Requirements (BEER) standards.

A 38. Albany Medical Center Hospital has a higher average mortality rate for CABG surgeries than some other
hospitals across the state. Which of the following is not a reason which could explain this finding:
A. since all CABG surgery patients are the same, the problem must be a confounding variable.
B. the risk adjustment methods for CABG patients is not perfect.
C. a teaching medical hospital attracts sicker patients.
D. confounding variables, which have not been controlled for, can raise the average mortality rate.

E 39. Clinical pharmacy services can have an effect on all of the following humanistic outcomes, except:
A. patient satisfaction with clinical services B. patient quality of life
C. patient motivation to adhere D. patient adherence
E. patient utilities

B 40. Improving patients’ motivation to adhere to treatment is related to pharmacists’ efforts to educate their
patients. Which of the following is an “unrecognized” benefit to pharmacists educating patients?
A. patients will have fewer medication errors.
B. patients will improve their interaction & compliance with other medical providers.
C. situational constraints which hinder communication will be increased.
D. patients will lower their expectations of our services, and it will be easier to satisfy them.
E. patients will raise their expectations of our services, and it will be easier to satisfy them.
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E 41. Which of the following is true about patients’ concept of “value” for clinical pharmacy services?
A. patients can experience “value” without being “satisfied” with clinical services.
B. increasing our patient’s concept of “value” requires marketing & advertising our services better.
C. the concept of “value” differs by patient, and hinges on the process involved.
D. patients can be satisfied with our services, but not value them enough to pay for them.
E. more than one of the above is true

B 42. When you prepare a project report for a high-level administrator, the report should contain a(n)
___________________ section which may be the only part of the report that is read.
A. Introduction B. Executive Summary
C. Data Analysis D. Conclusion
E. Limitations

B 43. All of the following are reasons why health surveys are not used routinely for every patient office visit, except:
A. the patient burden may be significant.
B. physician – patient communication is always increased.
C. the office staff burden may be significant.
D. educating clinicians to use these surveys properly is difficult.
E. using the surveys may increase a physician’s liabilities.

D 44. All of the following are potential benefits for using health surveys routinely for every patient office visit, except:
A. clinician – clinician communication may be increased.
B. clinician – patient communication may be increased.
C. patient treatment regimens may be modified.
D. provider adherence to treatment may increase
E. patient satisfaction may increase

C 45. When using a health survey for individual patient care, it is very important that the Cronbach’s alpha statistic
be as high as possible because:
A. the higher the value, the more valid is the survey.
B. the higher the value, the confidence intervals around the scores become larger.
C. the higher the value, the confidence intervals around the scores become narrower.
D. the higher the value, the more difficult it will be to detect changes in survey scores.
E. the higher the value, the higher will be the survey’s specificity.

Please read this:

1. There are two issues of a Pharmacoeconomics Journal missing from the library. If you have them, please
return them.
2. I have misplaced my laser pointer, which is also the remote control for the laptop. It will cost me $100 to
replace it. If you have it, would you put it in my faculty mailbox? It may have “showed up” at the exam
review…
3. Good luck on the remainder of your exams! Have a great summer and / or enjoyable rotations!

Sincerely, Leon Cosler

Last thing… Did you remember to sign the Honor Code?… Please and Thank You!