Podium Presentation Midwest Social and Administrative Conference,Chicago,2008
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Podium Presentation Midwest Social and Administrative Conference,Chicago,2008



Mail Order Pharmacy Vs. Community Pharmacy: Development of a Reliable and Valid HIV Patient Satisfaction Survey

Mail Order Pharmacy Vs. Community Pharmacy: Development of a Reliable and Valid HIV Patient Satisfaction Survey



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Podium Presentation Midwest Social and Administrative Conference,Chicago,2008 Presentation Transcript

  • 1. Abhilasha Ramasamy 1 M.Sc (Hons), B.Pharm, Sharrel Pinto 1 B.S. Pharm, Ph.D, Eric Sahloff 2 Pharm.D 1 Pharmacy Health Care Administration, 2 Department of Pharmacy Practice, College of Pharmacy, The University of Toledo, Toledo, Ohio
  • 2.
    • Introduction
    • Goal
    • Study Objectives
    • Methods
      • Study design
      • Instrument development
      • Subjects and Settings
      • Data collection
      • Data Analysis
    • Results
      • Construct Validity
      • Reliability and Item Analysis
    • Limitations
    • Conclusion
  • 3.
    • Patient satisfaction - important outcome measure.
    • Associated with patients’ quality of life, adherence to medication therapy, level of pharmaceutical care received. 1-3
    • Not many studies have measured patient satisfaction adequately.
    • Satisfied patients - maintain a good relationship with their health care provider, comply with medical regimens and cooperate with their health care provider. 4
  • 4.
    • Medication dispensing
    • Providing patients with drug education.
    • Medication therapy management.
    • Prescription refill reminders.
    • Blood pressure, blood glucose, and cholesterol monitoring.
    • Important to assess patient satisfaction due to increase in services provided by the pharmacy. 5
  • 5.
    • Mail Order Pharmacy
    • Community Pharmacy
    • Newer type of pharmacy.
    • Patients receive medication through mail.
    • Saves money compared to community pharmacy. 6
    • No face to face interaction between the patient and the pharmacist.
    • Delay in filling prescriptions.
    • Traditional pharmacy.
    • Patients get their prescription filled at the pharmacy.
    • Face to face interaction between the patient and the pharmacist
    • Pharmacy services to patients with chronic disease conditions results in increased clinical outcome, increased patient satisfaction, and increased quality of life. 7-13
  • 6.
    • HIV/AIDS-Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
    • Chronic disease requiring multiple medications with potential for adverse effects and drug interactions.
    • Providing pharmacy services to manage their complex disease state is important to these patients.
    • HIV- seropositive patients receive medications and related information from both community and mail order pharmacy.
    • Determining patient satisfaction of these patients with each of the distributive methods can help to improve patient care.
  • 7.
    • Designing and testing a survey for comparing HIV-infected patients’ satisfaction with services provided in a mail order pharmacy with those in a community pharmacy.
  • 8.
    • To conduct an exploratory factor analysis to measure the construct validity of the survey instrument.
    • To measure the internal consistency reliability of the survey using Cronbach’s alpha.
    • To conduct item analyses of the survey instrument.
  • 9.
    • Study design
    • Exploratory cross-sectional study using a convenience sample of HIV infected patients.
    • Received the Institutional Review Board approval from the University of Toledo.
    • Instrument development
    • Survey instrument included three sections: “General information”, “Evaluating pharmacy services”, and “Demographic section”.
    • Patient satisfaction scale d eveloped from Larson and Mackeigan survey. 14
    • F:MidwestHIV Patient Satisfaction Questionnaire.doc
  • 10.
    • Study Subjects
    • A convenience sample of HIV-infected patients receiving care at the University of Toledo Medical Center (UTMC).
    • Study subjects - Private Insurance, Medicare, Medicaid, and/or Ohio HIV Drug Assistance Program (OHDAP) also called the AIDS Drug Assistance Program (ADAP).
    • ADAP program - assistance to eligible patients to receive their HIV-related medications via mail order.
    • ADAP patients receive non-HIV related medications through community pharmacy.
  • 11.
    • Data Collection
    • Seven month period beginning November 2007.
    • Survey instrument provided along with a cover letter and a return envelope.
    • Survey administrators included clinic nurses, nurse practitioners, and pharmacists at the UTMC HIV outpatient clinic.
    • Completed survey returned to the survey administrator in a sealed envelope.
  • 12.
    • Data analysis
    • Data entered and analyzed using SPSS v. 15.0.
    • Construct validity-Exploratory factor analysis using Principal Components Analysis and varimax rotation.
    • Internal consistency reliability was tested using Cronbach’s alpha for all three pharmacy settings.
    • Item analysis tested for item discrimination, response location, and variabilit y.
  • 13.
    • At the end of the study period, 178 surveys were returned. The response rate was 90.4%.
    • Construct Validity
    • Exploratory factor analysis was conducted for the patient satisfaction scale of the survey instrument.
    • Prior to factor analysis, KMO, Bartlett, and Measures of Sampling Adequacy (MSA) tests were conducted to examine adequate sample size, sphericity, and correlations respectively.
    • Using Kaiser’s criterion, factor analysis resulted in a two factor solution for all the three types of pharmacy settings.
  • 14.
    • Construct Validity
    • For mail order, the two factor solution accounted for 73.61% of the total variance explained.
    • Independent-82.62% of the total variance explained.
    • Chain-70.81% of the total variance explained.
    • Each of the two factors met the eigen value >1 criteria.
    • F:MidwestFactor Analysis Results.doc
  • 15. Reliability and Item analysis Mail (N=69) Independent (N=50) Chain (N=72) Tests Factor 1 Factor 2 Factor 1 Factor 2 Factor 1 Factor 2 Item Means 3.55-4.38 2.83-4.06 3.53-4.21 2.88-3.27 3.49-4.31 2.81-3.62 Corrected total-item correlation 0.462-0.920 0.274-0.802 0.763-0.964 0.654-0.941 0.013-0.849 0.010-0.793 Cronbach’s alpha 0.951 0.795 0.977 0.965 0.841 0.823
  • 16.
    • Sub-domains identified by factor analysis - consistent with Larson and Mackeigan’s survey.
    • Exceptions- “Pharmacy representative takes efforts to solve problems with medications”.
    • “ Pharmacy representative does a good job explaining what medications do.”
    • High Cronbach’s alpha-Strong correlation between the items and patient satisfaction.
    • Item means-Good response location.
    • Variability-Good at measuring differences between individuals on the facets being measured.
    • Item total correlation-Strong positive correlation between the items and the total scale score.
  • 17.
    • Application of the survey instrument
    • Pharmacy settings.
    • Total patient satisfaction score-Summing the scores and dividing by the total number of items.
    • Can be used to compare across pharmacy settings.
    • Used to assess patient satisfaction before and after implementing a patient oriented service.
    • Survey patients at regular intervals to assess their satisfaction with pharmacy services.
  • 18.
    • Convenience sample.
    • Incomplete responses to the patient satisfaction section.
    • Section was moved up after the first question in the survey to increase responses to this section.
    • Future studies - consult patients about their perspectives on patient care services, and test the survey in other HIV infected population, other chronic disease states to provide external validity to the survey
  • 19.
    • Survey instrument-quantitative measure of patient satisfaction with pharmacy services.
    • Can measure patient satisfaction across various settings.
    • Pharmacies and health care payers can learn about patient satisfaction with health care services leading to improved patient-reported outcomes.
  • 20.
    • University of Toledo, Medical Center staff at HIV clinic who helped in administering the survey.
    • Organizers of the Midwest conference.
  • 21.
    • 1. Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end stage renal disease treated with hemodialysis. Semin Nephrol. 2006; 26(1):68-79.
    • 2. Bultman DC, Svarstad BL. Effects of pharmacist monitoring on patient satisfaction with
    • antidepressant medication therapy. J Am Pharm Assoc. 2002; 42(1):36-43.
    • 3. Ried LD, Wang F, Young H, et al. Patients' satisfaction and their perception of the pharmacist. J Am Pharm Assoc. 1999; 39(6):835-42.
    • 4. Aharony L, Strasser S. Patient Satisfaction: What we know about and what we still need to explore. Medical Care Review.1993; 50(1):49-79.
    • 5. Holiday-Goodman M, Darley WK, Lively BT, Siganga W, Deshmukh-Estoll HC.
    • Investigation of consumer choice of community, mail order, or internet pharmacies. J
    • Pharm technol . 2007; 23: 16-22.
    • 6. Sipkoff M. Mail Order Pharmacy Saves Money, Says PCMA, but at What Cost?
    • Managed Care . 2005; 60-61.
    • 7. Erickson SR, Slaughter R, Halapy H. Pharmacists' ability to influence outcomes of
    • hypertension therapy. Pharmacotherapy . 1997; 17(1):140-7.
  • 22.
    • 8. Sookaneknun, P, Richards R, Sanguansermsri J, et al . Pharmacist involvement in primary care improves hypertensive patient clinical outcomes. Ann Pharmacother . 2004; 38:2023-8.
    • 9. Vivian E. Improving blood pressure control in a pharmacist-managed hypertension clinic. Pharmacotherapy . 2002; 22:1533-40.
    • 10. Garcao JA, Cabrita J. Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal. J Am Pharm Assoc . 2002; 42:858-64.
    • 11. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc .2003; 43:173-84.
    • 12. Cranor CW, Christensen DB. The Asheville Project: Short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc . 2003; 43:149 -59.
    • 13. Shibley MCH, Pugh CB. Community pharmacy program for patients with hyperlipidemia. Annals of Pharmacotherapy . 1997; 31:713-719.
    • 14. Larson LN, Rovers JP, Mackeigan LD. Patient satisfaction with pharmaceutical care:
    • Update of a validated instrument. J Am Pharm Assoc .2002; 42:44-50.
  • 23.
    • QUESTIONS???