Development and validation of a patient-based measure of pharmaceutical care

Hema N Viswanathan, Purdue University

Abstract

The objectives of this study were to develop and validate a patient-based measure of pharmaceutical care and to examine associations between patient and pharmacy site characteristics and pharmaceutical care. The domains of pharmaceutical care identified from the literature were (1) establishing and maintaining the therapeutic relationship, (2) assessment, (3) establishing therapeutic goals, (4) implementing the therapy plan, (5) monitoring, and (6) documentation. Items were written for all domains except documentation because it cannot be directly assessed by patients. Content validity was assessed based on expert panel ratings. Respondent debriefing was conducted in six consecutive sessions to better understand respondents' interpretations of key terms. Items were pretested using 60 surveys collected at an outpatient pharmacy in a primary care center. Large scale validation was conducted using 352 surveys collected in three pharmacy sites. Inclusion criteria were being 18 years or older and visiting the pharmacy for one's own health-related needs. Reliability and validity were examined using Rasch analysis and confirmatory factor analysis. Two dimensions of pharmaceutical care were identified, one related to technical aspects of pharmaceutical care and another related to interpersonal aspects of pharmaceutical care. Item reduction resulted in a 21-item measure of technical aspects of pharmaceutical care with a person reliability of 0.93 and an 8-item measure of interpersonal aspects of pharmaceutical care with a person reliability of 0.82. Convergent validity was evident in a positive correlation between technical aspects of pharmaceutical care and interpersonal aspects of pharmaceutical care with patient satisfaction. Confirmatory factor analysis showed acceptable fit for the two factor solution. Respondents receiving new medications had significantly higher scores for technical aspects of pharmaceutical care, after controlling for pharmacy site, age, and gender. Respondents at a Veteran's Administration Clinic had higher mean scores for interpersonal aspects of pharmaceutical care than those at a primary care center. Person separation indices were 3.68 for the technical aspects scale and 7.98 for the interpersonal aspects scale, suggesting that the measures had good responsiveness. The measures for technical aspects of pharmaceutical care and interpersonal aspects of pharmaceutical care also detected significant differences across sites indicating sensitivity of the scales.

Degree

Ph.D.

Advisors

Thomas, Purdue University.

Subject Area

Pharmaceuticals|Psychological tests

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