Nursing Research—Principles and Methods

Objective To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD). Design Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used. Setting Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center. Interventions Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents. Main Outcome Measures Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL. Results Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients. Conclusion Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model.

Part 3. Humanistic Outcomes in the Hypertension and COPD Arms of a Multicenter Outcomes Study

Objective: To explore the relationships between patients' satisfaction and (1) the level of pharmaceutical care services received, (2) patients' perceptions of the personal attention paid to them by the pharmacist, and (3) patients' perceptions of the pharmacist's ability to help them manage their asthma and prevent asthma-related problems. Design: Exploratory study using mail or telephone survey methods. Patients or Other Participants: Asthma patients (n = 250) enrolled in one of two Florida managed care organizations. Main Outcome Measures: Predictor variables were level of pharmaceutical care and patients' perceptions of personal attention and their pharmacist's ability to help them control their asthma. Outcome variable was patients' overall satisfaction with the care they received from their pharmacist. Results: The direct causal effects of level of care (standardized regression coefficient, (3 = 0.07) and patients' perception of pharmacists' ability to help (p = 0.01) on satisfaction were nonsignificant. Only personal attention had a significant direct path coefficient to patient satisfaction ((3 = 0.63). Although the level of care was associated with patient satisfaction (r= 0.32), its direct effect was not significant because of its joint association (r = 0.27) with personal attention. Patients' satisfaction was associated with the level of pharmaceutical care and their perception of the pharmacist's ability to help them with their asthma. However, personal attention from the pharmacist was most influential. Conclusion: Patients may be less able to judge the technical quality of the care they receive, but they do judge their social interaction with the pharmacist. Pharmacy professionals must increase patients' awareness of the value of pharmaceutical care services and make it important to their judgment of satisfaction.

Patients’ Satisfaction and Their Perception of the Pharmacist

The development and validation of a survey instrument to assess consumer satisfaction with pharmacy services is discussed. The Pharmaceutical Care Satisfaction Questionnaire (PCSQ) is a 30-item instrument administered by someone other than the pharmacist that uses a Likert scale to score respondents' answers. The PCSQ is written approximately at a seventh grade reading level. Following initial development, the PCSQ was administered to 360 consumers in ambulatory pharmacies and to 311 patients in a multicenter hyperlipidemia outcomes study. The Cronbach coefficient alpha was .94 for the consumer data, with a 64.8% variance accounted for by the 4-factor solution. A coefficient alpha of .84 was found on all 30 items in the hyperlipidemia study, with a variance of 63.78% in control patients and 60.16% in treatment patients. The PCSQ is easy to administer and score, with minimal cost. Unlike other satisfaction surveys, the PCSQ contains patient evaluations regarding outcomes of care. A primary limitation of the PCSQ is that it is a newly developed instrument that needs to be used in more studies to strengthen its validity.

Development and validation of the pharmaceutical care satisfaction questionnaire.

Objective To assess the level of expectation and satisfaction of patients with asthma regarding the counseling provided by community pharmacists, and to identify the counseling information patients consider important in helping them manage their asthma. Design Mailed survey. Participants: 208 patients seen in the University of Utah Asthma Clinic for at least 3 months, age 18 years or older, and on at least 1 asthma medication. Main Outcome Measures: Frequency of pharmacist-provided asthma medication counseling, patients' perception of the importance of counseling, and their satisfaction with counseling. Results: Response rate was 55% (106 of 194 surveys returned). The majority of patients (> 90%) indicated that their community pharmacist "never" or "sometimes" discussed the management of their asthma with them. Frequency of counseling in three predefined areas of asthma education (role of medications, inhaler technique, and prevention of asthma attacks) was 1.91, 1.72, and 1.31, respectively (1=never, 4=always). Most patients (76%) considered these areas of counseling to be important for the management of their asthma. Most patients (62%) were "somewhat" to "pretty" satisfied with the type and amount of asthma counseling provided by their pharmacist. Counseling sessions averaged less than 3 minutes. Only 25% of patients would be willing to pay an additional amount for pharmaceutical care. Conclusion: Self-reported rates of patient counseling concerning asthma medications in the community pharmacy setting are low and adequately address neither the educational needs of patients nor the recommendations of the National Asthma Education and Prevention Program.

Asthma patients' satisfaction with the frequency and content of pharmacist counseling.

This prospective, randomized study was conducted to determine if increased patient contact between pharmacists and patients would result in greater patient awareness and satisfaction with their hospital stay and particularly with pharmacists and pharmacy services. Eligible patients were randomized to receive either the usual pharmacy care with minimum contact with the pharmacist, or expanded services based on increased contact with the pharmacist. A questionnaire was used to determine patient awareness and satisfaction. Statistically significant differences were found between the groups on awareness and satisfaction with pharmacy services scales as well as total scores. Total patient scores were highly reliable, with an alpha coefficient of 0.87. In addition, comments by patients in the group with increased contact were overwhelmingly positive, in contrast to those receiving usual care. Patients desire and appreciate greater contact with pharmacists.

Scott M. Waldrop

Papers

Patients' Perceptions of Increased Pharmacy Contact