- Email: [email protected]
PHP42 CORRELATION BETWEEN COLLEGE STUDENT ACTIVITIES AND TWO PRODUCTIVITY MEASUREMENTS
Abstracts
A34 taken in 4 evaluations (36%), perspective of health insurer was taken in 5 evaluations (45%), and perspective of the other 2 evaluations (18%) was obscure. Cost-effectiveness analysis was performed in 3 (27%), cost-utility analysis was performed in 5 (45%) and both were performed in 3 (27%) concurrently. The 6 submissions used modeling to evaluate and effectiveness was expressed in LYGs or QALYs in 11. Overall, the submissions satisfied with more than half of evaluation items were 7 (64%). There were 2 evaluations of disagreement over the choice of comparator. An inadequate time period of analysis was found in 4 (36%). There was no subgroup analysis though 5 submissions had differences in clinical effectiveness or costs among groups and indications. Sensitivity analysis was conducted in 9 (81%) but the question of uncertainty was handled unsatisfactorily. Most of studies had no special justification of its adoption into Korea even though the studies used the foreign clinical and epidemiologic data. CONCLUSION: In this assessment we evaluated the quality level of pharmacoeconomic studies and adherence of studies to the Korean guidelines. A lot of improvements are required with respect to handling uncertainty, validation of the model, time horizon and presentation of adequate subgroup analyses. PHP40 EFFECTS OF EDUCATIONAL INTERVENTION ON PRESCRIPTION WRITING IN PUBLIC AND PRIVATE HOSPITALS IN BENIN CITY, NIGERIA
Akoria OA, Isah A University of Benin, Benin City, Edo State, Nigeria OBJECTIVES: To determine to what extent prescriptions meet accepted standards, identify factors underlying poor prescription writing, intervene by educational means, and assess the impact of intervention. METHODS: Prescriptions from randomly selected doctors (40 in all) from 17 hospitals (9 private, 8 public) were collected retrospectively. Each was assessed for date, details identifying patient, medicine name, dosage, dosing frequency, duration of therapy and precautions as well as prescriber name, signature and address/phone number. Handwriting was assessed using a rating scale. Educational intervention was done by faceto-face interaction and group seminars, with impact evaluation 4 to 6 weeks later. RESULTS: A total of 1197 prescriptions were assessed. At baseline, more prescriptions from private hospitals had hospitals’ addresses (p = 0.005) and patients’ ages (p = 0.015). More from public hospitals were signed (p = 0.001). Only 20% of prescriptions were clearly legible. Post-intervention, more prescriptions from public hospitals were signed (p = 0.017); in private hospitals more prescriptions had the doses (p = 0.04) and routes (p = 0.05) of administration. Doctors from private hospitals who had educational intervention wrote the ages of patients more frequently than controls (p = 0.05). Doctors from public hospitals who participated in the group seminar wrote the dosing frequencies and routes of administration (p = 0.03 and 0.04 respectively) significantly more than those who had face-to-face education. Handwriting significantly worsened in both public and private hospitals post-intervention (p = 0.04, 0.02 respectively). Reasons given for poor prescription writing included heavy workload and non-availability of prescription order blanks. CONCLUSION: Prescriptions lacked several details that are required for the identification of patients as well as prescribers. The majority of prescriptions were illegible. Educational intervention resulted in some significant changes in some aspects of prescription writing, but it remains to be seen whether these changes would be sustained in the long-term. In the Nigerian setting group seminars yielded more positive results than face-to-face education.
PHP41 PHYSICIANS’ ATTITUDES TOWARD E-DETAILING: (A PILOT STUDY)
Alkhateeb FM, Doucette WR University of Iowa, Iowa city, IA, USA OBJECTIVES: Electronic detailing (e-detailing) has been introduced in the last few years by the pharmaceutical industry as a new communication channel through which to promote pharmaceutical products to physicians. E-detailing means using digital technology for promotion: internet, video conferencing and interactive voice response. The objectives of this study were to: 1) explore physicians’ attitudes toward e-detailing, and 2) describe physicians using of e-detailing METHODS: The sample was selected from a database of licensed physicians in Iowa maintained by the Office of Statewide Clinical Education Program. The survey was mailed to a random sample of 150 physicians. Each subject was contacted up to two times. Attitudes measures that used Likert scales were developed. Using independent t tests, we compared physician users and physician non users of e-detailing in the following attitudes and beliefs: absolute relative advantage, relative advantage with comparison to traditional detailing, compatability, complexity, credibility, applicability, and searchability. RESULTS: Of the 150 surveys, 1 was returned as undeliverable. A total of 38 usable responses were received, giving a response rate of 25.6%. Hence 38 responses were included in our study analysis. Of the 38 surveys received, 21 (55.3%) reported receiving invitation to participate in e-detailing programs. There were 10 (26.3%) physicians who reported using e-detailing: Five using video, four using virtual and one using both. The attitudes and beliefs of e-detailing users were significantly different from non users: users considered edetailing more compatible with their practice (p = 0.005), less complex (p = 0.042), having higher absolute relative advantage (p = 0.005), of greater relative advantage in comparison to traditional detailing (p = 0.035), having higher credibility (p = 0.025), possessing greater searchability (p = 0.007) and better applicability (p = 0.011). CONCLUSION: About one quarter of physicians reported using e-detailing. Physicians who use edetailing recognize its interactive and self-directed nature more than nonusers. E-detailing programs that readily fit in to physicians’ practice are viewed more favorably. PHP42 CORRELATION BETWEEN COLLEGE STUDENT ACTIVITIES AND TWO PRODUCTIVITY MEASUREMENTS
Dhing CW, Stein G, Pal S, Mackey ML St. John’s University, Queens, NY, USA OBJECTIVES: The objective of this study was to evaluate the correlation between college student activities and two productivity measurements: Motivated Strategy for Learning Questionnaire (MSLQ) and Social Adjustment Scale—Self Reported (SAS-SR). METHODS: This was a multi-site, cross-sectional study involving 6 universities in New York City and Long Island. Undergraduate students from St. John’s University, Stony Brook (SUNY), Fordham University, Lehman College (CUNY), John Jay College (CUNY), and Hunter College (CUNY) were asked to complete a questionnaire involving their social and extra-curricular activities in the last two weeks as well as the productivity portions of the MSLQ and SAS-SR measurements. RESULTS: A convenience sample of 381 undergraduate students responded to our study. Majority of the respondents were college seniors (35.4%), female (59.7%) and resided off-campus (60.8%) with either a family member or room mate (82.4%). The mean age of our sample was 23.0 years (SD = 5.7 years) with an average of 2.8 years (SD = 1.1 years) spent in college. Significant corre-
Abstracts lations (p < 0.05) were found between the MSLQ measurement and the number of hours college students spent with friends, studying, class missed, as well as the number of extra-curricular activities and alcohol consumed. The SAS-SR measurement, on the other hand, were significantly correlated (p < 0.05) with only the number of hours college students spent with friends and class missed. CONCLUSION: The MSLQ is a better indicator of student productivity in college than the SAS-SR. This is because the SAS-SR, which was originally developed to evaluate employee productivity, measures functional items that may be too sensitive for student-related activities. The MSLQ was designed to measure students’ study strategies. PHP43 ANALYSIS OF COMMUNITY PHARMACISTS’ INTERVENTIONS ON ELECTRONIC PRESCRIPTION ERRORS
Warholak-Jackson T1, Rupp MT2 1 University of Arizona, Tucson, AZ, USA, 2Midwestern University— Glendale, Glendale, AZ, USA OBJECTIVES: This analysis was conducted as part of a federally funded national pilot to evaluate electronic prescribing in the community practice setting. The objective was to measure the incidence and nature of prescribing errors on e-prescriptions that required active intervention by dispensing pharmacists to correct. METHODS: A panel of participating pharmacists reported their Medication Therapy Interventions (MTI) using a standardized documentation protocol. RESULTS: Data were reported from 68 participating chain pharmacies in 5 states during 312 work shifts between July and September, 2006. During the study pharmacists reviewed 2,690 e-prescription orders (new = 83.0%, refill = 17.0%) and intervened 102 times for an intervention rate of 3.8%. The rate at which pharmacists identified problems on new e-Rxs was found to be nearly twice that of refills (4.1% and 2.2%, respectively). The most common reason for pharmacists’ interventions on e-prescriptions was to supplement omitted information (31.9%), especially missing directions. Dosing errors were also quite common (17.7%). The most common response by pharmacists to e-Rx problems was to contact the prescriber (64.1%), consult the patient’s profile or medication history (12.8%), and/or interview the patient or the patient’s representative (9.4%). In most cases (56%), the e-Rx order was changed and the prescription was ultimately dispensed. In 15% of cases the e-Rx order was dispensed as written following clarification by the prescriber. In 10% of cases the prescription was not dispensed. An additional 12% of prescription issues remained unresolved. Pharmacists required an average of 6.07 minutes to conduct their interventions on problematic eprescription orders, representing an incremental dispensing cost of $4.74. CONCLUSION: Electronic prescribing has the potential to improve the safety and efficiency of patient care. However, as currently implemented in the community practice setting, it maintains selected threats to both. Best practice recommendations are offered to improve the implementation of this important technology. PHP44 PHARMACIST WORKLOAD AND PHARMACY CHARACTERISTICS ASSOCIATED WITH THE DISPENSING OF POTENTIALLY CLINICALLY IMPORTANT DRUG-DRUG INTERACTIONS
Malone DC1, Abarca J2, Skrepnek GH1, Murphy JE1, Armstrong EP1, Grizzle AJ1, Rehfeld RA1, Woosley RL3 1 University of Arizona, Tucson, AZ, USA, 2WellPoint Next Rx, West Hills, CA, USA, 3The Critical Path Institute, Tucson, AZ, USA
A35 OBJECTIVES: Drug-drug interactions (DDIs) are preventable medical errors, yet exposure to DDIs continues despite systems designed to prevent such exposures. The purpose of this study was to examine pharmacy characteristics that may be associated with dispensed potential DDIs. METHODS: This study combined survey data from community pharmacies in 18 metropolitan statistical areas with pharmacy claims submitted to 4 pharmacy benefit managers (PBM) over a 3 month period from January 1 to March 31, 2003. Pharmacy characteristics of interest included prescription volume, the number of full-time equivalent pharmacist and pharmacy staff, computer software programs and the ability to modify those programs with respect to DDI alerts, the use of technologies to assist in receiving, filling and dispensing medication orders, and prescription volume. The dependent variable in this study was the rate of dispensed medications that may interact. RESULTS: A total of 672 pharmacies were included in the analysis. On average (+/−SD), the respondents filled 1375+/−691 prescriptions per week, submitted 17,948+/−23,889 pharmacy claims to the participating PBMs, had 1.2+/−0.3 full-time equivalent (FTE) pharmacists per hour open, and 545 (81%) were affiliated with a chain drug store organization. Factors significantly related to an increased risk of dispensing a potential DDI included pharmacist workload (OR 1.03, 95% CI 1.028 to 1.048), pharmacy staffing (OR 1.10, 95% CI: 1.09 to 1.11), and various technologies (e.g., sophisticated telephone systems, internet receipt of orders and refill requests) that assist with order processing as well as the ability to modify DDI alert screening sensitivity and detailed pharmacological information about DDIs. CONCLUSION: This study found there was an increase in the risk of dispensing a potential DDIs and higher pharmacist and pharmacy workload, and use of dispensing automation systems. PHP45 DID FDAMA SECTION 114 LEAD TO A DECLINE OF ECONOMIC-CONTENT DRUG ADVERTISING IN MEDICAL JOURNALS?
Palmer JA, Neumann PJ, Timm AR Tufts-New England Medical Center, Boston, MA, USA OBJECTIVES: To quantify and characterize economic-content in pharmaceutical advertisements in leading medical journals from 1990–2003, and to determine if economic ads declined in journals after enactment of Section 114 of the 1997 Food and Drug Administration Modernization Act (FDAMA). METHODS: Two researchers reviewed all pharmaceutical advertisements in three leading general medical (New England Journal of Medicine, JAMA, and Annals of Internal Medicine) and three specialty journals (Circulation, Gastroenterology, Neurology) in three specified months each year for 2000 through 2003. Using a standardized data collection form, we investigated economic claims (e.g., ads using the words “value”, “price”, “savings”, “hospitalization”), as well as presence of supporting evidence. This work builds upon our previous research of economic claims from 1990–1999, using an identical methodology. We hypothesized that economic promotion in journals declined after 1997 FDAMA Section 114, because that law encouraged such promotion in direct-to-managed care communications and signaled the FDA’s growing vigilance over the area. RESULTS: We reviewed 2144 pharmaceutical ads from 1990–1999 and 779 from 2000–2003. Economic content occurred in 11.1% of ads in the 1990s, and 7.6% of ads in 2000–2003 (p = 0.0058). The frequency of economic ads peaked in 1997 at 16.2% and declined thereafter (test for trend: p = 0.0017), reaching a low of 6.3% in 2002. The presence of any supporting evidence for economic claims was similar in the 1990s and early 2000s
A34 taken in 4 evaluations (36%), perspective of health insurer was taken in 5 evaluations (45%), and perspective of the other 2 evaluations (18%) was obscure. Cost-effectiveness analysis was performed in 3 (27%), cost-utility analysis was performed in 5 (45%) and both were performed in 3 (27%) concurrently. The 6 submissions used modeling to evaluate and effectiveness was expressed in LYGs or QALYs in 11. Overall, the submissions satisfied with more than half of evaluation items were 7 (64%). There were 2 evaluations of disagreement over the choice of comparator. An inadequate time period of analysis was found in 4 (36%). There was no subgroup analysis though 5 submissions had differences in clinical effectiveness or costs among groups and indications. Sensitivity analysis was conducted in 9 (81%) but the question of uncertainty was handled unsatisfactorily. Most of studies had no special justification of its adoption into Korea even though the studies used the foreign clinical and epidemiologic data. CONCLUSION: In this assessment we evaluated the quality level of pharmacoeconomic studies and adherence of studies to the Korean guidelines. A lot of improvements are required with respect to handling uncertainty, validation of the model, time horizon and presentation of adequate subgroup analyses. PHP40 EFFECTS OF EDUCATIONAL INTERVENTION ON PRESCRIPTION WRITING IN PUBLIC AND PRIVATE HOSPITALS IN BENIN CITY, NIGERIA
Akoria OA, Isah A University of Benin, Benin City, Edo State, Nigeria OBJECTIVES: To determine to what extent prescriptions meet accepted standards, identify factors underlying poor prescription writing, intervene by educational means, and assess the impact of intervention. METHODS: Prescriptions from randomly selected doctors (40 in all) from 17 hospitals (9 private, 8 public) were collected retrospectively. Each was assessed for date, details identifying patient, medicine name, dosage, dosing frequency, duration of therapy and precautions as well as prescriber name, signature and address/phone number. Handwriting was assessed using a rating scale. Educational intervention was done by faceto-face interaction and group seminars, with impact evaluation 4 to 6 weeks later. RESULTS: A total of 1197 prescriptions were assessed. At baseline, more prescriptions from private hospitals had hospitals’ addresses (p = 0.005) and patients’ ages (p = 0.015). More from public hospitals were signed (p = 0.001). Only 20% of prescriptions were clearly legible. Post-intervention, more prescriptions from public hospitals were signed (p = 0.017); in private hospitals more prescriptions had the doses (p = 0.04) and routes (p = 0.05) of administration. Doctors from private hospitals who had educational intervention wrote the ages of patients more frequently than controls (p = 0.05). Doctors from public hospitals who participated in the group seminar wrote the dosing frequencies and routes of administration (p = 0.03 and 0.04 respectively) significantly more than those who had face-to-face education. Handwriting significantly worsened in both public and private hospitals post-intervention (p = 0.04, 0.02 respectively). Reasons given for poor prescription writing included heavy workload and non-availability of prescription order blanks. CONCLUSION: Prescriptions lacked several details that are required for the identification of patients as well as prescribers. The majority of prescriptions were illegible. Educational intervention resulted in some significant changes in some aspects of prescription writing, but it remains to be seen whether these changes would be sustained in the long-term. In the Nigerian setting group seminars yielded more positive results than face-to-face education.
PHP41 PHYSICIANS’ ATTITUDES TOWARD E-DETAILING: (A PILOT STUDY)
Alkhateeb FM, Doucette WR University of Iowa, Iowa city, IA, USA OBJECTIVES: Electronic detailing (e-detailing) has been introduced in the last few years by the pharmaceutical industry as a new communication channel through which to promote pharmaceutical products to physicians. E-detailing means using digital technology for promotion: internet, video conferencing and interactive voice response. The objectives of this study were to: 1) explore physicians’ attitudes toward e-detailing, and 2) describe physicians using of e-detailing METHODS: The sample was selected from a database of licensed physicians in Iowa maintained by the Office of Statewide Clinical Education Program. The survey was mailed to a random sample of 150 physicians. Each subject was contacted up to two times. Attitudes measures that used Likert scales were developed. Using independent t tests, we compared physician users and physician non users of e-detailing in the following attitudes and beliefs: absolute relative advantage, relative advantage with comparison to traditional detailing, compatability, complexity, credibility, applicability, and searchability. RESULTS: Of the 150 surveys, 1 was returned as undeliverable. A total of 38 usable responses were received, giving a response rate of 25.6%. Hence 38 responses were included in our study analysis. Of the 38 surveys received, 21 (55.3%) reported receiving invitation to participate in e-detailing programs. There were 10 (26.3%) physicians who reported using e-detailing: Five using video, four using virtual and one using both. The attitudes and beliefs of e-detailing users were significantly different from non users: users considered edetailing more compatible with their practice (p = 0.005), less complex (p = 0.042), having higher absolute relative advantage (p = 0.005), of greater relative advantage in comparison to traditional detailing (p = 0.035), having higher credibility (p = 0.025), possessing greater searchability (p = 0.007) and better applicability (p = 0.011). CONCLUSION: About one quarter of physicians reported using e-detailing. Physicians who use edetailing recognize its interactive and self-directed nature more than nonusers. E-detailing programs that readily fit in to physicians’ practice are viewed more favorably. PHP42 CORRELATION BETWEEN COLLEGE STUDENT ACTIVITIES AND TWO PRODUCTIVITY MEASUREMENTS
Dhing CW, Stein G, Pal S, Mackey ML St. John’s University, Queens, NY, USA OBJECTIVES: The objective of this study was to evaluate the correlation between college student activities and two productivity measurements: Motivated Strategy for Learning Questionnaire (MSLQ) and Social Adjustment Scale—Self Reported (SAS-SR). METHODS: This was a multi-site, cross-sectional study involving 6 universities in New York City and Long Island. Undergraduate students from St. John’s University, Stony Brook (SUNY), Fordham University, Lehman College (CUNY), John Jay College (CUNY), and Hunter College (CUNY) were asked to complete a questionnaire involving their social and extra-curricular activities in the last two weeks as well as the productivity portions of the MSLQ and SAS-SR measurements. RESULTS: A convenience sample of 381 undergraduate students responded to our study. Majority of the respondents were college seniors (35.4%), female (59.7%) and resided off-campus (60.8%) with either a family member or room mate (82.4%). The mean age of our sample was 23.0 years (SD = 5.7 years) with an average of 2.8 years (SD = 1.1 years) spent in college. Significant corre-
Abstracts lations (p < 0.05) were found between the MSLQ measurement and the number of hours college students spent with friends, studying, class missed, as well as the number of extra-curricular activities and alcohol consumed. The SAS-SR measurement, on the other hand, were significantly correlated (p < 0.05) with only the number of hours college students spent with friends and class missed. CONCLUSION: The MSLQ is a better indicator of student productivity in college than the SAS-SR. This is because the SAS-SR, which was originally developed to evaluate employee productivity, measures functional items that may be too sensitive for student-related activities. The MSLQ was designed to measure students’ study strategies. PHP43 ANALYSIS OF COMMUNITY PHARMACISTS’ INTERVENTIONS ON ELECTRONIC PRESCRIPTION ERRORS
Warholak-Jackson T1, Rupp MT2 1 University of Arizona, Tucson, AZ, USA, 2Midwestern University— Glendale, Glendale, AZ, USA OBJECTIVES: This analysis was conducted as part of a federally funded national pilot to evaluate electronic prescribing in the community practice setting. The objective was to measure the incidence and nature of prescribing errors on e-prescriptions that required active intervention by dispensing pharmacists to correct. METHODS: A panel of participating pharmacists reported their Medication Therapy Interventions (MTI) using a standardized documentation protocol. RESULTS: Data were reported from 68 participating chain pharmacies in 5 states during 312 work shifts between July and September, 2006. During the study pharmacists reviewed 2,690 e-prescription orders (new = 83.0%, refill = 17.0%) and intervened 102 times for an intervention rate of 3.8%. The rate at which pharmacists identified problems on new e-Rxs was found to be nearly twice that of refills (4.1% and 2.2%, respectively). The most common reason for pharmacists’ interventions on e-prescriptions was to supplement omitted information (31.9%), especially missing directions. Dosing errors were also quite common (17.7%). The most common response by pharmacists to e-Rx problems was to contact the prescriber (64.1%), consult the patient’s profile or medication history (12.8%), and/or interview the patient or the patient’s representative (9.4%). In most cases (56%), the e-Rx order was changed and the prescription was ultimately dispensed. In 15% of cases the e-Rx order was dispensed as written following clarification by the prescriber. In 10% of cases the prescription was not dispensed. An additional 12% of prescription issues remained unresolved. Pharmacists required an average of 6.07 minutes to conduct their interventions on problematic eprescription orders, representing an incremental dispensing cost of $4.74. CONCLUSION: Electronic prescribing has the potential to improve the safety and efficiency of patient care. However, as currently implemented in the community practice setting, it maintains selected threats to both. Best practice recommendations are offered to improve the implementation of this important technology. PHP44 PHARMACIST WORKLOAD AND PHARMACY CHARACTERISTICS ASSOCIATED WITH THE DISPENSING OF POTENTIALLY CLINICALLY IMPORTANT DRUG-DRUG INTERACTIONS
Malone DC1, Abarca J2, Skrepnek GH1, Murphy JE1, Armstrong EP1, Grizzle AJ1, Rehfeld RA1, Woosley RL3 1 University of Arizona, Tucson, AZ, USA, 2WellPoint Next Rx, West Hills, CA, USA, 3The Critical Path Institute, Tucson, AZ, USA
A35 OBJECTIVES: Drug-drug interactions (DDIs) are preventable medical errors, yet exposure to DDIs continues despite systems designed to prevent such exposures. The purpose of this study was to examine pharmacy characteristics that may be associated with dispensed potential DDIs. METHODS: This study combined survey data from community pharmacies in 18 metropolitan statistical areas with pharmacy claims submitted to 4 pharmacy benefit managers (PBM) over a 3 month period from January 1 to March 31, 2003. Pharmacy characteristics of interest included prescription volume, the number of full-time equivalent pharmacist and pharmacy staff, computer software programs and the ability to modify those programs with respect to DDI alerts, the use of technologies to assist in receiving, filling and dispensing medication orders, and prescription volume. The dependent variable in this study was the rate of dispensed medications that may interact. RESULTS: A total of 672 pharmacies were included in the analysis. On average (+/−SD), the respondents filled 1375+/−691 prescriptions per week, submitted 17,948+/−23,889 pharmacy claims to the participating PBMs, had 1.2+/−0.3 full-time equivalent (FTE) pharmacists per hour open, and 545 (81%) were affiliated with a chain drug store organization. Factors significantly related to an increased risk of dispensing a potential DDI included pharmacist workload (OR 1.03, 95% CI 1.028 to 1.048), pharmacy staffing (OR 1.10, 95% CI: 1.09 to 1.11), and various technologies (e.g., sophisticated telephone systems, internet receipt of orders and refill requests) that assist with order processing as well as the ability to modify DDI alert screening sensitivity and detailed pharmacological information about DDIs. CONCLUSION: This study found there was an increase in the risk of dispensing a potential DDIs and higher pharmacist and pharmacy workload, and use of dispensing automation systems. PHP45 DID FDAMA SECTION 114 LEAD TO A DECLINE OF ECONOMIC-CONTENT DRUG ADVERTISING IN MEDICAL JOURNALS?
Palmer JA, Neumann PJ, Timm AR Tufts-New England Medical Center, Boston, MA, USA OBJECTIVES: To quantify and characterize economic-content in pharmaceutical advertisements in leading medical journals from 1990–2003, and to determine if economic ads declined in journals after enactment of Section 114 of the 1997 Food and Drug Administration Modernization Act (FDAMA). METHODS: Two researchers reviewed all pharmaceutical advertisements in three leading general medical (New England Journal of Medicine, JAMA, and Annals of Internal Medicine) and three specialty journals (Circulation, Gastroenterology, Neurology) in three specified months each year for 2000 through 2003. Using a standardized data collection form, we investigated economic claims (e.g., ads using the words “value”, “price”, “savings”, “hospitalization”), as well as presence of supporting evidence. This work builds upon our previous research of economic claims from 1990–1999, using an identical methodology. We hypothesized that economic promotion in journals declined after 1997 FDAMA Section 114, because that law encouraged such promotion in direct-to-managed care communications and signaled the FDA’s growing vigilance over the area. RESULTS: We reviewed 2144 pharmaceutical ads from 1990–1999 and 779 from 2000–2003. Economic content occurred in 11.1% of ads in the 1990s, and 7.6% of ads in 2000–2003 (p = 0.0058). The frequency of economic ads peaked in 1997 at 16.2% and declined thereafter (test for trend: p = 0.0017), reaching a low of 6.3% in 2002. The presence of any supporting evidence for economic claims was similar in the 1990s and early 2000s