Showing papers in "Research in Social & Administrative Pharmacy in 2008"

Core reporting practices in structural equation modeling.

Abstract: Background Structural equation modeling (SEM) is a popular analysis technique because of the wide range of questions that it can help answer. There are several pieces of information specific to SEM that should be reported when this technique is used. Objectives To demonstrate a basic framework for reporting SEM analyses, to provide definitions of key terms readers will encounter, and to illustrate 2 examples for reporting SEM results. Methods Data from 650 participants who completed 3 self-report surveys were used to test a confirmatory factor analysis and a structural model as examples of information to be reported. Results The results displayed are requisite information for any SEM analysis. Conclusions It is important for investigators to provide this information so that readers can properly evaluate the results and conclusions based on the analyses.

A descriptive study of self-medication practices among Palestinian medical and nonmedical university students.

Abstract: Background The implications of self-medication practices are increasingly recognized around the world; however, little has been reported on the extent of self-medication practiced in Palestine. Objective To determine the reasons, extent, and correlates of self-medication practices among university students in Palestine. Methods A self-administered questionnaire eliciting self-medication practices was distributed to university students in a cross-sectional design. The 4 variables, sex, type of school, self-care orientation, and medication knowledge, were investigated for possible correlation with self-medication practices. Multiple logistic regression and Chi-square statistics were used in data analysis. Results Self-medication practices were reported by 98% of the surveyed students (n = 1581). Approximately two thirds of the respondents reported a high self-care orientation and one third reported “good” medication knowledge. Multiple logistic regressions indicted that self-care orientation, medication knowledge, and sex were insignificant predictors of self-medication practices, whereas the type of school (P = .012) was a significant predictor. A significant relation between the 4 variables and the type of therapeutic class used in self-medication was observed. For example, males were more inclined to use antiallergic medications (OR = 1.48) than females. Medical students were more likely to use laxatives/antidiarrheal agents (OR = 1.49) than nonmedical students. Respondents with high a self-care orientation were more inclined to use headache relievers (OR = 2.22) compared to those with low self-care orientation. The most commonly reported reason for self-medication practices was simplicity of the illness encountered. Conclusion Self-medication practices were common among the university students studied. Sex, type of school, self-care orientation, and medication knowledge are important personal factors that are associated with the selection of certain types of therapeutic classes used in self-medication.

A modified model of pharmacists' job stress: the role of organizational, extra-role, and individual factors on work-related outcomes.

Abstract: Background Understanding the effects of job stress continues to be a concern for health-care providers as workload and personnel needs increase. Objective The overall objective of this study was to test a direct effects model of job stress that examines the characteristics of the organizational environment (interpersonal interactions, environmental aspects, the level of compensation and advancement, role stress, and availability of alternative jobs); extra-role factors (work-home conflict); job stress; individual factors (career commitment); and the work-related psychological outcomes of job satisfaction, organizational commitment, and job turnover intention. Methods A cross-sectional mail survey was sent to a nationwide random sample of 4895 licensed pharmacists in the United States. Previously validated summated Likert-type scales measured each of the study variables. Data analyses included descriptive statistics, and exploratory and confirmatory factor analyses. Structural equation modeling was used to estimate the final model. Results A response rate of 46% was achieved. Psychometric analyses indicated acceptable reliability and validity. The study model fit the data well (CFI [comparative fit index] = 0.90, RMSEA [root mean square error of approximation] = 0.05). Organizational factors in the form of role overload (standardized β = 0.45) and conflict (0.31) and ease of finding a job with better interpersonal characteristics (0.26) had the largest effects on job stress. Interpersonal characteristics were also one of the strongest predictors of job satisfaction (−0.61) and organizational commitment (−0.70). Work-home conflict directly affected job turnover intention (0.11) and career commitment (−0.16). Other significant, but sometimes, opposite direct effects were found. Job satisfaction and organizational commitment directly affected job turnover intention. Conclusions Given the increased demand for pharmacy services, health-care organizations will benefit from increasing positive and reducing negative work outcomes. Increased focus on enhancing interpersonal interactions, developing commitment to the profession, and greater consideration of nonwork factors could help pharmacists better manage their work environments. Future research should continue to refine these models to further enhance our understanding of the effects of job stress in the health professional workplace.

Association between diabetes patients' knowledge about medications and their blood glucose control.

Abstract: Background Diabetes mellitus is a common chronic disorder frequently resulting in hyperglycemia and numerous long-term complications. Research has shown that improved glycemic control reduces the rate and number of diabetes-related complications. Evidence suggests that patients who are more knowledgeable about diabetes self-care may be more likely to achieve better glycemic control. Objective The purpose of this study is to determine the relationship between patients' knowledge about their diabetes medications and their blood glucose control. Methods Patients receiving oral pharmacologic treatment for type 2 diabetes mellitus were asked to answer a short questionnaire assessing their knowledge about their medications. Patients were part of an ambulatory care practice in Baltimore, Maryland, that provides primary care medical services to an inner-city, predominantly African American population. A medication knowledge score (number of correct responses to 8 components) was tabulated and correlated to the most recent glycosylated hemoglobin (A1c) (drawn within the previous 90 days). Multivariate models were constructed, with A1c as the outcome and patients' medication knowledge as the independent variable. Potential confounders included in the models were age, sex, education level, number of diabetes medications, and insurance status. Results Fifty patients were screened for the study; 44 agreed to participate and met inclusion criteria. Patients' diabetes medication knowledge scores ranged between 1 and 7, with a median score of 5. Older patients (65 years and older) and male patients scored lower than their counterparts. There was a strong inverse association between knowledge score and A1c (r = −0.61; P Conclusion Patients with greater understanding and knowledge of their diabetes medications demonstrated better glycemic control. This cross-sectional association of medication knowledge and A1c was more pronounced in women than in men.

Using focus groups to inform pharmacy research

Abstract: Background Focus groups are a powerful research tool for collecting qualitative information across many contexts. The focus group offers pharmacy researchers benefits that support many of the important lines of investigation at the forefront of contemporary pharmacy-based research, particularly within the areas of patient compliance/concordance, customer behavior, patient-provider collaboration, health literacy research, and disease management. This article introduces the focus group as a research method that offers powerful investigative potential to researchers who are attempting to understand human-based phenomena. Objectives To provide sufficient background, examples, and how to information to enable a pharmacy researcher to include focus group methodologies in their initial design decisions, and provide guidance to additional resources necessary for successful implementation of this powerful qualitative approach. Methods The article is organized into sections describing what a focus group is and what it can be used for; the unique benefits and drawbacks of using focus group methodology; organization and planning considerations including participant and recruitment considerations; and sampling strategies, session and question development, practical details of session management, and follow-up activities, including data analysis. Results/Conclusion Although often considered quick and easy focus groups require thoughtful consideration of need and purpose, considerable planning, and effort to succeed. Because of the unique insight that can be gained, their flexibility, and their ability to mesh with other methods, focus group is gaining currency as an important research tool within health care.

Utilization, price, and spending trends for antidepressants in the US Medicaid Program.

Abstract: Background Antidepressants are often used in the treatment of major depressive disorder and other mental illnesses, and constitute one of the most widely prescribed and costly medication classes in the US Medicaid Program. However, antidepressant utilization and price patterns within this market have not yet been adequately characterized. Objectives This study was undertaken to analyze antidepressant drug utilization and price trends and to quantify market-share competition in Medicaid. Methods Quarterly utilization and payment data were retrieved from the national Medicaid pharmacy claims files provided by the Centers for Medicare & Medicaid Services. Quarterly per-prescription prices were estimated by dividing the payment amounts by the number of prescriptions. Descriptive time series analysis was conducted to assess the trends of utilization, expenditures, market shares, and prices from January 1991 through December 2005, for 3 major antidepressant subclasses—Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants, and Other Antidepressants—as well as for individual agents within these subclasses. Using exponential smoothing models, 3-year market-share forecasts were produced. Results From 1991 to 2005, the total number of antidepressant prescriptions rose 380% from 6.82 million to 32.72 million. Total expenditures on antidepressants increased from $159 million in1991 to $2.26 billion in 2004, then decreased to $1.99 billion in 2005, following the entry of lower-priced generic fluoxetine in 2001 and generic paroxetine in 2003. The payment market share for the SSRIs increased from 40% in 1991 to 82% in 1997, then decreased to 64% in 2005. It is projected to be 64% (95% confidence interval [CI]: 51-77%) in 2008 quarter 4. Conclusions Increases in antidepressant drug expenditures were primarily because of rising utilization; however, there was also some increase in average price per prescription for many of the antidepressants studied. Switching to generic drugs may offer significant cost-saving potential.

The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women

Abstract: Background Little is known about postmenopausal women's health beliefs and preventative behaviors regarding osteoporosis. Determining their beliefs and behaviors regarding osteoporosis can be helpful in developing effective interventions for osteoporosis prevention. Objectives To use the Health Belief Model to assess the associations between postmenopausal women's osteoporosis health beliefs and osteoporosis preventative behaviors. Methods Using a self-administered survey, data were obtained from a convenience sample of 187 postmenopausal (≥65 years of age) women, with no history of osteoporosis at a community pharmacy and senior nutrition sites in central Texas. The independent variables included health beliefs (susceptibility to osteoporosis, severity of osteoporosis, benefits and barriers of calcium intake, benefits and barriers of exercise, health motivation, self-efficacy of calcium intake and exercise) and modifying factors (demographics and risk factors). Calcium intake and exercise were the dependent variables. Multiple regression was used to assess the relationships between health beliefs and modifying factors with calcium intake and exercise. Results The respondents' mean age was 75.4 ± 6.5 years, and Mexican Americans comprised approximately 40% (39.6%) of the sample. Their reported calcium intake (mean ± SD) was 1604.7 ± 907 mg/d and they engaged in 5 hours ([mean ± SD]: 5.1 ± 5.3) of weight-bearing exercise per week. Self-efficacy of calcium intake and self-efficacy of exercise had significant ( P P Conclusions Self-efficacy was significantly associated with postmenopausal women's performance of osteoporosis preventative behaviors. Improving postmenopausal women's confidence in engaging in appropriate calcium intake and weight-bearing exercise behaviors may be beneficial to osteoporosis prevention.

Content analysis methods for conducting research in social and administrative pharmacy.

Abstract: Background Content analysis is a research technique used to systematically collect and analyze the makeup and exchange of communication through various visual, auditory, and print media. It has been used in health care to study communications to audiences using a broad range of media. Objective The purpose of this article is to introduce the methodology of content analysis and suggest some recommendations for its use. Methods A review of steps used in content analysis are provided and illustrated using 2 examples of pharmacy advertising research to highlight major ideas, delineate problems faced when using the methodology, and describe how issues were resolved. Results The quality of content analysis studies depends on using clear definitions of study constructs, explicit sampling methods, systematic analysis and reporting of data, and inferences that incorporate current research evidence. Transparent methods that permit reproducibility of results are essential. Conclusions Ultimately, good content analysis depends on the skill, competence, diligence, and integrity of trained researchers.

Evaluating medication-related services in a hospital setting using the disconfirmation of expectations model of satisfaction.

Abstract: Background Patient satisfaction is considered an important outcome measure of services and associated with behavioral intentions. The appraisal process commonly used in satisfaction models is the disconfirmation of expectations. A patient compares his or her experience to preexisting expectations. The resulting satisfaction from this comparison is dependent on whether the patient's expectations are superior, inferior, or just as expected. Objectives The aims of this study were to (1) determine the relationship between disconfirmation of expectations with medication-related services and patient satisfaction with medical care; and (2) determine if patient satisfaction is related to the likelihood to say good things about the medical care provided at the hospital to family and friends. Methods A cross-sectional, nonexperimental study design was implemented to test the disconfirmation of expectations model. Patients on warfarin therapy and recently discharged from an acute care hospital to their homes were surveyed by mail. The survey asked about how well the hospital services related to medication therapy met patient expectations. Satisfaction with medical care and the likelihood of positive word of mouth regarding the medical care were also measured. Structural equation modeling (SEM) was used to test the model. Results The survey response rate was 34% (n = 187). Factor analysis of the 7 disconfirmation of expectation items resulted in a 2-factor solution: (1) medication counseling and (2) discharge medication services. The SEM demonstrated that the model was significant; however, the disconfirmation of expectation items did not significantly relate to the 1-item satisfaction measure. Patient satisfaction and the behavioral intentions measures were significantly related. A post hoc analysis using SEM demonstrated that the disconfirmation of expectations factors did significantly relate to a higher-order latent construct. This construct also related to patient satisfaction. Conclusion The disconfirmation of expectations has a role in a postservice experience response expressed by the patient, but not as a direct antecedent to patient satisfaction. Opportunities to improve the model are the use of a multi-item satisfaction measure and the inclusion of patient affect.

Women's knowledge, preferences, and practices of modern contraceptive methods in Woreta, Ethiopia.

Abstract: Background Inadequate family planning services are problematic in Ethiopia. Understanding determinants in contraceptive methods use may be instructive in the design of interventions to improve family planning outcomes. Objectives To assess determinants of preferences, knowledge, attitudes, and practices of modern contraception among women of reproductive age in Woreta town. Methods A community-based, cross-sectional study was conducted in Woreta town, South Gondar zone, Ethiopia in April 2007. A multistage sampling procedure was carried out to interview 400 women in the study area. A pretested structured questionnaire was used for data collection. Results Eighty-nine percent of respondents were aware of modern contraceptives. Among respondents, 88% knew of at least 2 methods, and 12% knew only 1 method. More than 90% of respondents reported positive attitudes toward modern contraceptive use. The major reasons for nonuse of modern contraceptive methods (MCMs) were being single and a desire for more children. Injectables were the most commonly preferred modern contraceptive (63.2%) followed by oral contraceptive pill (21.2%). Few women reported a preference for the use of condoms (9.5%) or implants (6.1%). Conclusions Respondents reported at least modest knowledge of MCMs; however, the results suggest a need for improving accessibility and education among women in this section of Ethiopia.

The uses and benefits of cluster analysis in pharmacy research.

Abstract: Purpose Cluster analysis (CA) refers to a set of analytic procedures that reduce complex multivariate data into smaller subsets or groups. Compared with other data reduction methods, such as factor analysis, CA yields groupings that are based on the similarity of whole cases, as opposed to the individual variables that comprise those cases. CA represents a valuable analytic tool for the health sciences, and may be used to devise patient or consumer profiles, or in the development of classification systems or taxonomies. CA has become a more widely used analytic tool because before the advent of personal computers with high processing power, CA methods were too complex to be time efficient. Yet in the past few decades, interest in and the applied use of CA have advanced considerably. CA tools are now integrated into most popular statistical software packages and are therefore more accessible. Methods The authors provide a discussion of CA that seeks to introduce the various methods, issues, and considerations to the researcher who is largely unfamiliar with CA. A conceptual understanding of CA is guided through breaking down CA into a series of steps and issues to consider including composition of the dataset, selection of variables, decisions about standardizing variables, selecting a measure of association, selecting a clustering method, determining the number of clusters, and interpretation. Results/Conclusions Because the range of CA methods is diverse, and because the steps within each method are so varied, an attempt to offer a complete “how-to” process in a single article is imprudent. Rather, the novice reader will be able to use this article as a starting point for conducting his or her own particular CA study.

Comparing 4 classification systems for drug-related problems: processes and functions.

Abstract: Background Counseling patients on drug-related problems (DRPs) is a new enterprise for pharmacists. Accordingly, a variety of classification systems have been created to document DRPs. This aroused ...

Potential determinants of prescribers' drug-drug interaction knowledge.

Abstract: Background Health care professionals' ability to recognize potential drug-drug interactions (potential DDIs) is important in reducing the risk of potential DDIs and their adverse consequences. Until now, little is known about the determinants of prescribers' potential DDI knowledge. Objectives This study was conducted to develop interval scales to evaluate prescribers' potential DDI knowledge and perceived usefulness of various potential DDI information sources, and to examine demographic and practice factors that may be related to prescribers' knowledge of potential DDIs. Methods Data were obtained from a national mail survey of prescribers who were determined from pharmacy claims obtained from a pharmacy benefits manager to have prescribed at least 1 drug involved in a potential DDI, and a control group who had prescribed either 1 of the medications in the drug combinations of interest. The survey instrument included 14 drug-drug pairs that evaluated prescribers' ability to recognize clinically important potential DDIs and 5-point Likert scale-type questions that assessed prescribers' perceived usefulness of potential DDI information provided by various sources. The knowledge and usefulness questions were examined via Rasch dichotomous and rating scale models, respectively. Results A total of 950 completed surveys were included in the analysis (overall adjusted response rate: 7.9%). Rasch analysis of knowledge and usefulness items revealed satisfactory model-data-fit (infit mean square [MNSQ] ≦ 1.5 and outfit MNSQ ≦ 2.0) and moderate person reliability of 0.72 and 0.61, respectively. Multiple regression analysis revealed that compared with generalists, specialists had lower potential DDI knowledge test scores. In addition, poorer potential DDI knowledge was associated with a lack of clinical experience witnessing harm caused by a potential DDI. Also, the prescribers whose drug selections were affected by the risk of potential DDIs “very much” scored higher than those who reported that their prescribing was affected by the risk “a little” or “not at all.” Conclusions This study found that specialists were less likely to correctly identify interactions compared with generalists. Other important predictors of potential DDI knowledge included the experience of seeing a potential DDI-caused harm and the extent to which the risk of potential DDIs affected prescribers' drug selection.

Healthy children's perceptions of medicines: A review

Abstract: Background Chronically ill children's perceptions of medicines have been widely studied, but healthy children's less often. However, information on healthy children's beliefs and attitudes about medicine use is needed to be able to target health education messages about medicines appropriately. Objectives A literature review was performed to determine schoolchildren's attitudes, beliefs, and knowledge about medicines; autonomy in using medicines; expectations of using medicines; and questions about medicines, so as to guide the development of a medicine education curriculum and to inform health care professionals who communicate with children. Methods This study was a review of literature from 17 countries. Results The review indicated that children of school age tend to view medicines cautiously. Although age is a factor, children have very limited ideas about how medicines work and issues around medicine efficacy are confusing to them. Even young children recognize that medicines may have harmful effects and, children of all ages and cultures studied want to learn more about medicines. Autonomy in medicine use is surprisingly high and disturbing given that knowledge of medicines is poor. Conclusions Primary conclusions drawn are (1) children of the same age in different cultures appear similar in their attitudes, beliefs, behaviors, and desires to learn about medicines; (2) children lack information about medicines, especially in view of their levels of autonomy; and (3) health educators and health care professionals should educate children about rational medicine use, at appropriate cognitive development levels, before the children become independent medicine users.

Pilot study of a hierarchical Bayes method for utility estimation in a choice-based conjoint analysis of prescription benefit plans including medication therapy management services

Abstract: Background Consumers face an array of multiattribute prescription benefit insurance programs that include different access points (retail, supermarket, Internet, etc) and levels of pharmacist interaction (including medication therapy management services [MTMSs]). Because of this, there is a need for more sophisticated information to drive prescription benefit plan design. Objectives A pilot study to determine if choice-based conjoint (CBC) analysis with hierarchical Bayes (HB) estimation for individual level part-worths could provide a stable model for attribute preferences for prescription benefit insurance; to pilot test the addition of MTMSs to a prescription benefit management model; and to pilot and compare logit-based utility estimates to HB estimations in a conjoint market simulator. Methods A mail-based survey was conducted using a random sample of 1500 residents of the United States. A CBC analysis instrument was developed to provide a single-stated choice from a selection of different prescription benefit plans. Choice tasks were varied based on the attributes: co-payment, pharmacy access, formulary, level of pharmacist interaction including MTMSs and monthly premium. Analysis included logit-based and HB estimation for utilities, and preference share market simulation testing. Results The utility estimations from HB analysis were consistent with those seen in the logit-based analysis. A goodness of fit of 83% (root likelihood) was achieved in the HB utility estimations with only 4 choice tasks per respondents and the inclusion of MTM-like services. There was convergence on preference shares from the market simulation between the 2 estimation methods. Conclusions The use of CBC analysis with HB estimation provided utilities similar to those estimated using aggregated logit-based methods, with the added benefit of respondent specific part-worth scores for each attribute level. A larger sample, changes in the instrument design, more panels (tasks) per respondent, and selection of conjoint methods may allow for more predictive information from market simulators.

Using an action research process in pharmacy practice research--a cooperative project between university and internship pharmacies.

Abstract: Background Action research (AR) is a common research-based methodology useful for development and organizational changes in health care when participant involvement is key. However, AR is not widely used for research in the development of pharmaceutical care services in pharmacy practice. Objectives To disseminate the experience from using AR methodology to develop cognitive services in pharmacies by describing how the AR process was conducted in a specific study, and to describe the outcome for participants. Methods The study was conducted over a 3-year period and run by a steering group of researchers, pharmacy students, and preceptors. The study design was based on AR methodology. The following data production methods were used to describe and evaluate the AR model: documentary analysis, qualitative interviews, and questionnaires. Results Experiences from using AR methodology and the outcome for participants are described. A set of principles was followed while the study, called the Pharmacy-University study, was being conducted. These principles are considered useful for designing future AR studies. Outcome for participating pharmacies was registered for staff-oriented and patient-oriented activities. Outcome for students was practice as project leaders and enhancement of clinical pharmacy-based skills. Outcome for researchers and the steering group conducting the study was in-depth knowledge of the status of pharmacies in giving advice to patient groups, and effective learning methods for students. Conclusion Developing and implementing cognitive pharmaceutical services (CPS) involves wide-reaching changes that require the willingness of pharmacy and staff as well as external partners. The use of AR methodology creates a platform that supports raising the awareness and the possible inclusion of these partners. During this study, a set of tools was developed for use in implementing CPS as part of AR.

Utilization of a community pharmacy-operated national drug information call center in Finland

Abstract: Background Provision of drug information has been identified as a key strategy to prevent adverse drug events; however, provision of drug information in face-to-face consultations between patients and health professionals is often suboptimal. Objective The objective of the study was to analyze and describe utilization of a community pharmacy-operated national drug information call center. The special focus was on calls concerning prescription drugs. Method Trained pharmacists (n = 20) recorded data from all telephone calls made to the Helsinki University Pharmacy drug information call center over a 1-week period by using a structured data collection instrument. Data of this cross-sectional study were quantitatively content-analyzed to compute descriptive statistics. Results Data were recorded for 2196 calls, 56% of which were drug-related. Of the drug-related calls, 79% were related to prescription drugs. The majority (83%) of these calls were therapeutic or pharmaceutical inquiries, with 26% concerning costs and reimbursements, 14% interactions, 14% dosages, and 11% adverse effects. Nervous system drugs (Anatomical Therapeutic Chemical [ATC] classification N), anti-infectives (J), and musculoskeletal drugs (M) accounted for 20%, 18%, and 13% of the calls, respectively. Nonsteroidal anti-inflammatory drugs (NSAID) (9% of the calls), antidepressants (6%), and penicillin (5%) were the most often inquired about ATC-subgroups. A majority (82%) of the callers were estimated to be between 20 and 60 years of age. Conclusion Consumers appear to have multiple unmet drug information needs. This may especially be the case for certain population groups, and in regard to nervous system drugs, anti-infectives and NSAID. Drug information call centers operated by community pharmacies could complement face-to-face information provided by health professionals.

Factors affecting demand among older adults for medication therapy management services.

Abstract: Background Medicare Part D took effect in January 2006 with requirements for prescription drug plans to provide medication therapy management (MTM) services to targeted Medicare beneficiaries. The use of Medicare Part D MTM is voluntary by Medicare beneficiaries and no research evidence is available that can inform policy makers of the beneficiary and provider access-level circumstances under which older adults are more likely to demand MTM-like services. Objective The objective of this study was to describe the effects of the characteristics of older adults and their provider access on the demand for MTM services using data from a unique pre-Medicare Part D program for Medicare-eligible older adults in Iowa. Methods A retrospective cohort study using enrollment, claims, and provider data from the Iowa Priority Prescription Savings (IP) Program. The dependent variable was whether the IP members obtained the MTM service offered by the program. Logistic regression was used to assess whether IP member characteristics and their provider access affected the probability of the IP member to obtain the MTM service. Results Demand for the service varied with IP member age, gender, monthly number of drugs taken, monthly prescription drug spending, self-reported health status, having alternative insurance, and seeing multiple physicians. Increased access to pharmacies promoting the service increased IP member demand. Conclusion The demand for MTM-like services varies with the characteristics of older adults and their access to providers that promote the service. Older adults who view themselves as sicker and those with more complex medication regimens appear more likely to demand a service, suggesting that the benefits of the service are either more important or more recognizable to them. However, it appears that older adults require contact with pharmacies that promote MTM services to recognize this value.

"I just don't know what I'm supposed to know": evaluating self-assessment skills of international pharmacy graduates in Canada.

Abstract: Background Self-assessment skills are an integral part of pharmacy education and practice, yet there is very little empirical evidence in health professions to indicate that students and practitioners possess adequate and appropriate self-assessment skills. Objectives To evaluate self-assessment skills of international pharmacy graduates (pharmacists from outside Canada or the United States seeking licensure in Canada). Methods An 8-station objective structured clinical examination was used. Within each station, 2 trained and experienced pharmacist raters completed analytical and global assessments of participants. After each station, participants themselves completed the same assessments, as well as providing additional anecdotal feedback regarding their performance. In stations possessing sufficient interrater reliability, comparisons were made between raters' assessments and self-assessments. Results Across all performance quartiles there was a discrepancy between self-assessments and rater assessments of clinical performance. The discrepancy was largest in the lowest quartiles, suggesting impairment of self-assessment may be greatest amongst those who have the weakest skills. Conclusions Not all individuals possess adequate and appropriate self-assessment skills. Further work is required to elucidate the link between clinical competence and self-assessment and to determine methods for improving self-assessment skills.

Development and validation of the patient trust in community pharmacists (TRUST-Ph) scale: results from a study conducted in Thailand.

Abstract: Background The quality of the pharmacist-patient relationship has been examined in various perspectives, for example patient satisfaction. Trust is another concept within which the quality of the relationship might be examined and is critical in contemporary pharmacy practice. Objective To develop and validate a scale to measure patient trust in community pharmacists. Methods A 5-dimension conceptual model of trust, which includes fidelity, competence, honesty, confidentiality, and global trust, was originally used for scale development. Candidate items were generated and revised using expert reviews, focus group discussion, and think aloud method in the first phase. The items and their revisions were tested in 2 successive phases. Data were collected from 2 convenience samples of 400 each in Songkhla and Yala provinces of Thailand. Factor analysis and item analysis were used to determine dimensions and refine items of the trust scale. Internal consistency and construct validity of the scale were determined. Results At first, exploratory factor analysis showed that the most interpretable solution consisted of 2 factors labeled Benevolence and Technical Competence. The Technical Competence had unsatisfactory internal consistency (Cronbach's alpha r =0.70, P Conclusions The developed scale (TRUST-Ph) to measure patient trust in community pharmacists had relatively high validity and reliability. It had 3 dimensions, which were Benevolence, Technical Competence, and Communication. The TRUST-Ph scale can be potentially used as a measure of patient-reported outcome for community pharmacist services.

Care ideologies reflected in 4 conceptions of pharmaceutical care.

Abstract: Background Different ways to practice pharmaceutical care have been developed. One expression of this fact is the existence of many different classification systems to document drug-related problems (DRPs). Evidence suggests that classification systems have different characteristics and that these characteristics reflect different conceptions of pharmaceutical care. To increase the understanding of conceptions of pharmaceutical care, underlying values and beliefs (ideologies) can be explored. Objective To explore various conceptions of pharmaceutical care to identify the care ideologies on which these conceptions are based. Methods Representatives of 4 selected conceptions of pharmaceutical care were interviewed in face-to-face meetings. During the interviews, 4 basic questions were asked. Three were focused on pharmaceutical care and 1 on DRPs. Interview transcripts were analyzed by an inductive method inspired by grounded theory. The conceptions studied were Strand , Granada-II , PCNE v5.0 , and Apoteket . Results In Strand , patients are given a more active role in the pharmaceutical care process, as compared to Granada-II , PCNE v5.0 , and Apoteket . Pharmacists in all the conceptions of pharmaceutical care assume they have special knowledge that patients benefit from. However, they use their knowledge in different ways in the various pharmaceutical care conceptions. In Strand , individual goals of drug therapy are established together with the patient, whereas in Granada-II , PCNE , and Apoteket goals are not explicitly discussed. The identified differences correspond to different care ideologies. Conclusions The pharmaceutical care conceptions are based on different care ideologies. The ideology is expressed in how therapy goals are set and patient needs defined. Strand is based on a patient-centered ideology; patient therapy goals and needs are defined by the patient together with the practitioners. Granada-II , PCNE , and Apoteket are based on an evidence-based medicine approach; patient therapy goals and needs are defined by the practitioners, based on available scientific knowledge.

Evaluation of consumer satisfaction using the tetra-class model.

Abstract: Background A number of studies have shown the importance of consumers' satisfaction toward pharmacy services. The measurement of patient satisfaction through different elements of services provided is challenging within the context of a dynamic economic environment. Patient satisfaction is the result of long-term established habits and expectations to the pharmacy as an institution. Few studies to date have attempted to discern whether these changes have led to increased patient satisfaction and loyalty, particularly within developing nations. Objectives The objective of this study was to evaluate the elements of the services provided in Bulgarian pharmacies and their contribution to consumer satisfaction using a tetra-class model. Three main hypotheses were tested in pharmacies to validate the model in the case of complex services. Additionally, the contribution of the different service elements to the clients' satisfaction was studied. Methods The analysis was based on a survey of customers in central and district pharmacies in Sofia, Bulgaria. The data were analyzed through a correspondence analysis which was applied to the results of the 752 distributed questionnaires. Results It was observed that different dimensions of the pharmacies contribute uniquely to customer satisfaction, with consumer gender contributing greatly toward satisfaction, with type/location of pharmacy, consumer age, and educational degree also playing a part. The duration of time over which the consumers have been clients at a given pharmacy influences the subsequent service categorization. Conclusions This research demonstrated that the tetra-class model is suitable for application in the pharmaceutical sector. The model results could be beneficial for both researchers and pharmacy managers.

Use/misuse of over-the-counter medications and associated adverse drug events among HIV-infected patients.

Abstract: Background Self-medication practices and polypharmacy are common among human immunodeficiency virus (HIV)-infected patients. Inappropriate use of over-the-counter (OTC) medications potentiates the risk for drug misuse and adverse drug events (ADEs). Objectives To investigate use and misuse of OTC medications in HIV-infected patients and determine related ADEs. Methods A nonexperimental cross-sectional field study design was used. Study subjects were HIV-infected patients from a local HIV clinic in Houston, TX. Information on subject demographics, OTC medication use, and ADEs experienced were obtained using combined self-administered questionnaire and personal interview techniques. Misuse was divided into 3 categories: strength/frequency misuse, length misuse, and condition misuse. Data were analyzed using descriptive and Chi-square analyses. Results A total of 215 completed surveys were obtained, with a net response rate of 63.6%. The mean (±SD) age of the respondents was 45 (±8.32) years and 69% were males. Analgesics/antipyretics (64.2%) were the most commonly used OTC medications of which nonsteroidal agents accounted for the greatest proportion (38.4%). Of the respondents, 80 (37.2%) misused OTC medications. The highest incidence occurred in length misuse (46.3%), followed by strength/frequency misuse (45.6%), and condition misuse (8.1%). Categories of misuse overlapped in 30 cases (20.1%). Thirty-six (16.7%) participants experienced at least one or more ADEs related to OTC medication use/misuse. Occurrence of ADEs was significantly higher in patients who misused OTC medications compared with those who did not ( P Conclusions Analgesics/antipyretics were the most commonly used OTC medications by HIV-infected patients. The incidence of misuse and ADEs associated with OTC medications were documented with the sample. Keeping in mind the limitations of study design, our findings suggest that misuse of OTC medications in HIV-infected patients may increase the incidence of ADEs experienced.

Development of a measure to assess pharmacy students' beliefs about monitoring chronic diseases

Abstract: Background Pharmacy students in the community setting are ideally situated to help patients monitor chronic diseases; however, their beliefs toward monitoring patients' health are not known. Objectives Study objectives are to identify relevant survey constructs and survey measures about monitoring beliefs, establish their psychometric properties, and describe students' beliefs about monitoring. Methods Four constructs that assess pharmacy students' monitoring beliefs were identified through literature review and pilot research: self-efficacy, outcome expectancies, role beliefs, and mattering. Measures of each construct were adapted or developed. The psychometric properties of each scale were evaluated in fourth year pharmacy students. A confirmatory factor analysis (CFA) was used to provide evidence for the factor structure of the scales and validity. Internal consistency reliability was assessed with Cronbach's alpha. Finally, students' responses were described. Results The response rate was 94% (119 of 127 students). A CFA revealed that a 5-factor model with the elimination of 2 questions was a better fitting model than the originally proposed 4-factor model. Reliability was good for scales except the negative outcome expectancies. Overall, students had positive attitudes toward their monitoring role and were “rather sure” they could routinely monitor. Conclusions Evidence was provided for the psychometric properties of new measures of monitoring specific self-efficacy, outcome expectancies, and monitoring role orientation, as well as a new measure of general mattering for pharmacy. These instruments have the potential to help pharmacy practice researchers assess pharmacy students' and ultimately pharmacists' beliefs about monitoring.

Self-efficacy in counseling in Norwegian chain pharmacies: a cross-sectional study.

Abstract: Background After pharmacy reform in Norway in 2001, pharmacy chains have systematically trained their personnel in advising self-medication of some symptoms and diseases to increase their competence. It may be important to reveal factors at work that increase self-efficacy in counseling as part of enhancing good pharmacy practice. Objectives The aims of this study were to investigate (1) self-efficacy in counseling among pharmacy personnel in respect to a range of medical complaints, and (2) the relationship between self-efficacy in counseling and pharmacy staff's education, age, years of work in pharmacy and psychosocial factors. Methods A web-based questionnaire about self-efficacy in counseling, psychosocial factors, and demographic variables was completed by 693 individuals from 299 randomly selected community chain pharmacies in Norway. Multiple regression analysis was used to assess the relationship between self-efficacy and gender, age, years of work in pharmacy, and psychosocial factors. Results On a scale from 0 (very difficult) to 10 (no problem), the mean score for self-efficacy on all 21 symptoms or needs was 7.2 (SD=1.3). Allergy, flu, and headache received the highest self-efficacy scores and leg ulcer treatment, self-test kits, and tiredness received the lowest scores. Significant associations between self-efficacy in counseling and years of work in pharmacy ( P =.017), role clarity ( P P =.002), and role conflict ( P Conclusions Self-efficacy in counseling among pharmacy personnel seems to be high for providing advice for symptoms where over-the-counter medicines are available. Role clarity, positive challenge, and years of work in pharmacy are associated positively with self-efficacy in counseling, whereas role conflict is associated negatively. Future research may examine implications for self-efficacy in actual behavior and patient outcomes.

An evaluation of the validity of inferences made from 3 diabetes assessment instruments: a Rasch analysis.

Abstract: Background Many patients who have diabetes lack adequate knowledge, positive attitudes, and sufficient resources to achieve optimal outcomes in the management of their disease. A key to assessing the impact of pharmacists' interactions with diabetes patients is the resultant impact on patient knowledge, attitudes, and satisfaction. As such, it is important that quality instruments be used to obtain accurate and dependable measures of these outcomes. Objective To evaluate the validity of inferences made from 3 separate diabetes instruments used in the assessment of patient knowledge, attitudes, and satisfaction. Methods This pilot study enrolled 30 patients with diabetes mellitus to evaluate the following 3 instruments: (1) Check Your Hemoglobin A1CIQ , (2) the revised Diabetes Questionnaire , and (3) a satisfaction questionnaire. The instruments were used to assess patient knowledge of diabetes and diabetes-related complications, attitudes toward having diabetes mellitus, and satisfaction with the services provided in a pharmacist-run diabetes clinic, respectively. Rasch analysis was used to determine if the instruments were able to measure the concepts they are intended to measure when used in this sample. Results After evaluating the 3 instruments, it was determined that Instrument 1 displayed construct underrepresentation and some mistargeting. Moreover, Instrument 2 demonstrated reasonably good rating scale function but exhibited construct underrepresentation and ceiling effects. Finally, Instrument 3 did not meet the necessary requirements for proper rating scale function and displayed ceiling effects and mistargeting. Conclusions This pilot evaluation suggested that none of the instruments were useful in this population, which reinforces the need for researchers to use item response theories to examine the psychometric properties of instruments used in reporting various patient outcome measures. Pharmacists and other health care professionals should be alerted to potential problems with the validity of inferences made from underperforming instruments, so as to prevent inaccurate conclusions.

Medical Expenditure Panel Survey: A valuable database for studying racial and ethnic disparities in prescription drug use

Abstract: Background Despite the importance of equal access to prescription drugs by racial and ethnic groups, studies on access to prescription drugs have been incomprehensive. Objective To describe the Medical Expenditure Panel Survey (MEPS) as a valuable data source to study racial and ethnic disparities in prescription drug use. Methods Use of the MEPS database to study disparities in prescription drug use is detailed. This includes strengths and limitations of the database, as well as key methodological, sampling, and statistical issues to consider when using it. Results Using MEPS allows researchers to control for sociodemographic and health status information when studying racial and ethnic disparities in prescription drug use. MEPS has taken measures to improve reliability of the information on the utilization of prescription drugs. An additional benefit of MEPS is that it has oversampled Hispanics, Blacks, and Asians; as such, it affords the statistical power to examine these minority groups. One limitation of MEPS is the inability of researchers to study some drug categories, because of limitations in statistical power. Moreover, the names of the prescription medications are not standardized in MEPS, and some information is not publicly available in MEPS databases. When conducting studies requiring information not publicly available, researchers may commute to the MEPS Data Center or may request the Data Center to run statistical programs for them. Conclusions Using MEPS to study racial and ethnic disparities in prescription drug use has significant benefits. Nonetheless, researchers need to keep in mind the limitations of using MEPS.

Patients' views on the UK policy of prescription charges—Insights from qualitative interviews

Abstract: Background Some UK evidence exists, which suggests that the cost of prescription charges can pose a barrier to accessing medication. However, little evidence exists on patients' more general views on the policy of prescription charges. Objectives The aim of this study was to explore the views of nonexempt patients, suffering from chronic conditions requiring regular medication, on the UK policy of prescription charges and how this could be improved. Methods Patients aged between 18 and 59 years (ie, potentially paying charges) were approached through 6 General Practices in Northwest England. Thirty asthma, 8 coronary heart disease, and 23 hypertension patients were interviewed in depth. Results Numerous interviewees were appreciative of the National Health Service, recognized its cost pressures and accepted paying toward medication in principle. A few though disagreed with charges on top of national insurance contributions. Many felt the level of the charge was too high. To protect population groups potentially vulnerable to issues of affordability, interviewees suggested that 2 principles should underpin any prescription charges policy: People on low incomes and essential medication treating chronic conditions should be exempt or subsidized. There was extensive discussion on the current grounds for medical exemption, which many viewed as not meeting these principles well or fairly, as well as the grounds for age-related exemptions. Conclusions This study has highlighted a number of principles and options that should be considered by the UK Governments when reviewing the prescription charges policy. It puts these in context of the ongoing public consultations commissioned by UK Governments.

Hypertension management in outpatient visits by diabetic patients.

Abstract: Background Hypertension is a common comorbidity among patients with diabetes. Few national studies have examined hypertension management in diabetic patients and even fewer studies have examined prescribing of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), the recommended first line of treatment in hypertensive diabetic patients. Objective This study examined hypertension management, including behavioral therapy and pharmacotherapy, in a nationally representative sample of outpatient visits by diabetic patients. Methods The 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey were used to examine hypertension management in patients with diabetes and hypertension. Descriptive analysis was used to evaluate utilization of behavioral therapy and pharmacotherapy in hypertensive diabetic patients. Multivariate analysis was used to examine prescribing variation in the use of ACE inhibitors and ARBs in hypertensive diabetic patients. Results An estimated 34 million outpatient visits were made by hypertensive diabetic patients in 2003-2004. Blood pressure >130/80 mm Hg was found in 66% of the outpatient visits by hypertensive diabetic patients. Nearly 57% of these visits involved educational and counseling services, with 53% receiving diet and nutrition services. In 71% of these visits antihypertensive agents were used, with 49% involving 2 or more antihypertensive agents. ACE inhibitors and ARBs were prescribed in 36% and 19% of the visits, respectively. Multivariate analysis found that patients with blood pressure >130/80 mm Hg were more likely to receive ACE inhibitors or ARBs and patients of other races, especially American Indians, were less likely to receive ACE inhibitors or ARBs. Conclusions The study found that although behavioral therapy and pharmacotherapy are often used for hypertension management in diabetic patients, optimal blood pressure was observed in only one third of the visits. Targeted efforts are needed to increase the use of ACE inhibitors or ARBs to improve hypertension management in diabetic patients.

Effects of repeated callbacks on response rate and nonresponse bias: Results from a 17-state pharmacy survey

Abstract: Background Although surveys are the most common method of data collection in research in the social & behavioral pharmaceutical sciences, little evidence exists on pharmacists' and pharmacies' patterns of telephone survey participation and the impact of repeated callbacks on minimizing nonresponse bias. Objectives To (1) describe final disposition of the survey sample, (2) describe the effect of repeated callbacks on response rate, and (3) examine whether hard-to-contact cases differ from those that are relatively easier to contact in terms of general pharmacy characteristics and characteristics specific to survey topics. Methods This study used a cross-sectional descriptive survey design that gathered information from key informants of 2558 community pharmacies in 17 states. Telephone interviews were conducted using a Computer Assisted Telephone Interview system. Final disposition of the sample units and the final response rate were reported. General pharmacy characteristics and characteristics specific to immunization delivery (ID) and emergency preparedness and response (EPR) activities were compared across different ease-of-contact levels. Results A total of 1707 pharmacies (66.7%) completed the interview; 757 (29.6%) were eligible cases that were not interviewed; 8 (0.3%) and 86 (3.4%) were cases of unknown eligibility and ineligibility, respectively. The final response rate was 69.1%. The number of calls to pharmacies was most productive on the first 9 calls and leveled off after the 14th call. When comparing characteristics among different ease-of-contact levels, 2 out of 3 characteristics related to ID activities were different. No differences were found in general pharmacy characteristics and characteristics specific to EPR activities, however. Conclusion The greater number of callbacks resulted in higher response rates due to greater number of completed interviews. The increase in response rate did not rule out nonresponse bias, however. Hard-to-contact cases differed from relatively easier to contact cases in terms of characteristics related to the survey topic, but not general characteristics.