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

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.

Effectiveness of a weekly faculty conversation forum about teaching.

OBJECTIVE: To evaluate the effectiveness of holding weekly 60-90 minute conversation forums for faculty members to discuss, explore, and reflect on various teaching topics in a relaxed, informal, interactive format. METHODS: Weekly, 60-90 minute sessions were held for faculty members of the University of Illinois College of Pharmacy. A 15-item retrospective pretest-posttest questionnaire was developed and administered at the end of the first year of implementation to evaluate the participants' perceived knowledge, abilities, and confidence gains relative to becoming effective educators. RESULTS: Eleven faculty members completed the questionnaire. All respondents tended to agree (6/11) or agreed (5/11) that their confidence as educators improved after attending the conversation forums. In addition,7 respondents tended to agree and 4 agreed that their ability to self-assess their teaching had improved. CONCLUSIONS: An ongoing weekly conversations forum provides faculty members opportunities to explore and learn about facets of teaching in a safe, informal environment.

The development and performance validation of a tool to assess patient anticoagulation knowledge.

BACKGROUND: The complexity of anticoagulation therapy requires a patient's command of anticoagulation-related knowledge to assist in maintaining optimal therapy and reducing adverse events. Verbal evaluations may overestimate the patient's comprehension of anticoagulation knowledge. OBJECTIVES: This first phase study developed and pilot tested the Anticoagulation Knowledge Assessment (AKA) instrument, and provided validity evidence to support the use of the AKA. The AKA is an assessment instrument that (1) pharmacists can use to obtain objective evidence of patient anticoagulation knowledge, (2) can provide pharmacists with direction for patient-specific medication management education, and (3) functions as a tool for continuous quality improvement in anticoagulation education. METHODS: Using objective measurement methods, a convenience sample of 60 English-speaking patients receiving services from an inner-city and suburban pharmacist managed anticoagulation clinics was used in conjunction with objective measurement methods. RESULTS: Rasch analysis of 32 multiple-choice items representing 10 anticoagulation educational content areas demonstrated misfit statistics of less than 1.2. All 60 patients demonstrated person misfit statistics of less than 1.3. The educational content area was well represented and distributed. CONCLUSIONS: Because the AKA performed well, the data support that information gained from the AKA will provide pharmacists with direction for anticoagulation management education that is targeted to each patient's specific needs. Additionally, responses demonstrated objective data about those components of practice that are being taught effectively.

Clinicians' responses to direct-to-consumer advertising of prescription medications.

BACKGROUND: The direct-to-consumer advertising (DTCA) of prescription medications is proliferating in the United States. The relationship between patient exposure to DTCA and the response of clinicians is not well understood. METHODS: A randomized postal survey of Arizona primary care provider physicians (n = 1080) and physician assistants (n = 704) was conducted. A questionnaire was created using a hypothetical patient scenario that varied according to the diagnosis of the patient (ie, hypertension, hypercholesterolemia, seasonal allergies, or obesity) and the type of informational exposure generating the patient's questions (ie, DTCA vs drug references such as Physicians' Desk Reference). Clinicians were randomly assigned 1 of 8 forms of the scenario and were asked standardized questions related to their responses when faced with the patient scenario. RESULTS: The response rate was 44% (40.5% of physicians and 49.3% of physician assistants). No statistically significant differences were found between the early and late responders or between responders and nonresponders. Relative to clinicians who received the "drug reference book" patient scenario, clinicians who received the DTCA patient scenario were more likely to become annoyed with a patient for asking for more information about medications (P =.003); less likely to answer the patient's questions (P =.03) or provide additional written information (P =.007); more likely to become frustrated (P =.003) and annoyed (P<.001) with the patient for asking to try a specific medication; and less likely to provide samples (P =.001) or a prescription (P<.001) for a specific medication. CONCLUSION: Clinicians are amenable to patients asking for drug information and medications, but they are less receptive to questions arising from DTCA.