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1. LITERATURE REVIEW

An extensive review of books and periodicals was conducted to provide a basis for the research efforts. The literature search was initiated at the National Library of Medicine in Bethesda, Maryland. The Library's computer was used to obtain a bibliography of materials related to the problem of drug diversion. A list of over 5,000 medical periodicals was obtained. However, less than 2 percent of the materials reviewed pertained to the study.

A further search was conducted at the major medical, legal, and general libraries in the Washington, D.C., area. The institutions surveyed included:

• The Drug Enforcement Administration Library • The Department of Justice, Main Library Howard University, Medical, Dental, and Pharmacy Library

• Library of Congress

• U.S. Supreme Court Library.

In addition, unpublished material in the form of minutes of conferences between Federal agency officials and State practitioners, and unpublished studies completed by DEA, DHEW, and other executive agencies, were obtained and reviewed.

Research materials on drug abuse and control were also provided by the professional associations. Many materials not otherwise available were found by using this procedure. Also, over 25 in-depth interviews were conducted with officials from Federal agencies and State and national associations. More than 200 books, publications, and periodicals were reviewed.

The literature review provided a readily available research data base. This data base was used in the following areas:

• Drug abuse

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Other drug-related topics.

2. SURVEY OF
LEGISLATION,
STATUTES, AND
REGULATIONS

A comprehensive effort to obtain State statutes and regulations for each of the professions of concern was undertaken at the inception of this study. The information received was collected and filed by State and is now a part of the DEA library.

A list of points of inquiry was adopted. Each of these points was addressed to provide a satisfactory assessment of the regulatory boards. Based upon the points of inquiry, a review was conducted for each of the 50 States and the District of Columbia.

A number of key points were established. Each issue had an impact on the overall study as specific data were obtained, or were identified as not available from the statutes. The data collected related to the following three areas:

• Information regarding the operational structure of boards, including:

Financial data such as States' board budgets and license fees

Detailed staffing information on investigative, clerical, and professional personnel.

• Interaction among governmental agencies responsible for regulation of health professionals • Functions performed by States' professional associations and licensing boards, particularly as these functions related to the nomination of licensing board members.

These key points were important in establishing the scope of the field survey and in the developing of the nationwide survey questionnaires.

Although most of the literature review was complet 3. EXPLORATORY FIELD

ed during the first quarter, additional material was obtained as the study continued. As the members of the survey team became directly involved in the drug-related problems of State regulatory bodies in the health professions, more literature was uncovered and reviewed.

SURVEY

An exploratory field survey was conducted in the States of Maryland, New York, and Virginia.

The survey was designed to aid in the development of the nationwide survey questionnaire of the health care regulatory boards and professional associations of the individual States. It was also intended to assess difficulties involved in obtaining information which was not available from the legislative review.

Several issues affected the scope of subsequent activities:

• Financial information from licensing boards was made available only after personal interviews were conducted with the executive secretary or similar representative of the boards.

Data relating to the investigation and prosecution of licensees were not immediately available. In some cases, access to this information was very difficult to obtain.

• Attempts to collect information through mailed requests to the interviewees were largely unsuccessful.

• Interaction among the various agencies concerned with regulation of health care professionals was noted after interviews with key personnel in these organizations.

• Interaction among the professional associations and the licensing boards was noted after interviews with the leaders of both the associations and the licensing boards.

It was determined that requests for most types of information could be handled effectively through interviews with State health care professionals. However, data relating to disciplinary actions against licensees and financial information would be more difficult to obtain.

It was also found that information not available at the time of the interview was frequently not mailed as promised. The impact of this problem upon the probable response rate to the questionnaire was assessed.

In summary, the field survey revealed the kinds of information which were readily available and those which were not. The project technical team was then able to address specific problem areas in the design and development of the nationwide questionnaire survey.

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Opinions from State government and professional leaders regarding possible benefits of potential recommendations. These recommendations were formulated from the working model. Opinions were also requested on the acceptability of such recommendations to the States and the agencies concerned with the regulation of health care professionals.

Thirteen different types of questionnaire were developed for the board and association survey. Two types of questionnaire were sent to each of the professions. One type was sent to State boards; the other was sent to State societies and/ or associations. The different types of questionnaire were as follows:

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Because health care practitioners will spend only a limited amount of time completing a questionnaire, relative ease in reading the questions is necessary to ensure a favorable response rate.

To meet the above constraints, the services of a graphic artist were used to design the questionnaires. An extensive review was then undertaken.

Draft questionnnaires were first presented to and discussed with Federal agency officials from NIDA, FDA, and DEA on a number of occasions. Their comments and suggestions were incorporated in the final versions.

The reviewed draft questionnnaires were then presented to several associations of State boards and national professional associations. These included the National Association of Boards of Pharmacy, the American Association of Dental Examiners, the American Dental Association, the American Medical Association, the American Veterinary Medical Association, and the American Osteopathic Association. The review comments provided by these professionals were likewise incorporated in the questionnaires.

Upon completion of the review effort, the results were compiled and analyzed. The questionnaires were then revised and submitted to the Federal Office of Management and Budget for a review required by statute.

Consequently, it was not possible to administer a sequential series of questionnaires to the respondent population. Therefore, to enable the project team to collect information, validate findings, and obtain recommendations on a simultaneous basis on each professional association and board questionnaire, graphic artists were used to design a three-part multipurpose questionnaire to obtain status data, validate findings, and assess acceptability of proposed recommended changes.

(4) Administration of the

Nationwide Survey

In order to administer properly the numerous three-part questionnaires used in the nationwide survey, it was necessary to validate the list of selected professionals by contacting the various State regulatory boards and professional associations. In this effort a number of problems were considered:

• The national associations do not always maintain current mailing lists of elected officers of the State boards and associations. This situation can be attributed to the frequency of turnover of elected officers.

April and May seem to be the months during which many associations conduct elections of new officers. This factor further complicated efforts to identify the proper respondents.

• Direct telephone contact was necessary to identify the selected respondents' capability to re

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Composition of respondent sample by size of State

• Maintenance of confidentiality of response.

Each of these topics is discussed in detail. Supporting tasks indicating the respresentatives' responses to the questionnaires are also described.

Initial Response and Follow-Up Efforts

The initial response to the questionnaire indicated a generally high level of interest in the questions posed. At least one questionnaire was returned by each State respondent group. Follow-up efforts began one month after the questionnaires were mailed. The cutoff period used to assess the level of initial response occurred one week after the initial follow-up activity, or five weeks after the initial mailing of the questionnaires. Table 1 provides a tabulation of the questionnaire responses by profession for both the initial round of responses and the total of all

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