Assessment of response shift using two structural equation modeling techniques.

OBJECTIVE: To identify response shift using two structural equation modeling (SEM) techniques. STUDY DESIGN AND SETTING: Hypertensive patients (n = 909) with coronary artery disease (CAD) completed SF-36 surveys at both baseline and 1-year follow-up. Response shift was identified using Oort and Schmitt SEM techniques. The type of response shift linked to changes in various parameters of the SEM measurement model is defined differently for both SEM approaches. Effect sizes were calculated for the impact of response shift on the change of SF-36 domain scores when using the Oort approach. RESULTS: Both Oort and Schmitt SEM approaches identified response shift only in the SF-36 physical functioning (PF) scale. The effect size of recalibration on the change of PF domain scores when using the Oort approach was -0.12. CONCLUSION: This study showed that hypertensive patients with CAD experienced a response shift over a 1-year period. Both the SEM approaches identified response shift (uniform recalibration using the Oort approach and recalibration using the Schmitt approach); however, both approaches use different parameters to define and test response shift. We found that either the variation in analytic methods or the sample used may influence the identification and type of response shift.

Patient counseling practices in U.S. pharmacies: effects of having pharmacists hand the medication to the patient and state regulations on pharmacist counseling.

OBJECTIVES: To determine the amount and type of oral counseling given to shoppers posing as new patients with new prescriptions and to determine how state regulations, pharmacy and pharmacist characteristics, and environmental factors affect oral counseling practices. DESIGN: Cross-sectional, observational, correlational study. SETTING: 41 states and the District of Columbia between January 28 and March 31, 2008. PARTICIPANTS: 365 community pharmacy staff members had interactions with shopper-patients. INTERVENTION: Shoppers presented new prescriptions in community pharmacies and recorded observations related to oral communication with pharmacy staff. MAIN OUTCOME MEASURES: Oral provision of medication information and risk information to shoppers by pharmacy staff, as well as questions asked of shoppers by pharmacy staff. RESULTS: Some form of oral communication related to a medication was reported in 68% of encounters. At least one informational item for either medication was provided for approximately 42% of encounters. At least one risk information item was provided in 22% of encounters. Logistic regression findings indicated that the strongest predictor of oral counseling, either providing information or asking questions, was the pharmacist being the pharmacy staff member who handed the medication to the patient, controlling for all other variables in the models. In addition, having strict state regulations specifying that pharmacists must counsel all patients receiving new prescriptions predicted whether patients received counseling. A more private area for prescription pick up also was a significant predictor. CONCLUSION: The importance of the direct encounter between the pharmacist and patient and strict state regulations mandating that pharmacists counsel patients with new prescriptions were highlighted by these findings.

Constructs underlying community pharmacy dispensing functions relative to Florida pharmacy technicians.

OBJECTIVES: To assess pharmacist and pharmacy technician opinions on functions community pharmacy technicians should perform. DESIGN: Cross-sectional and descriptive. SETTING: Florida community pharmacies during August and September 2004. PARTICIPANTS: Random sample of Florida community pharmacists (n = 2,000) and Certified Pharmacy Technicians (n = 2,000). INTERVENTION: Self-administered mail questionnaire. MAIN OUTCOME MEASURES: Participant attitudes (6-point Likert-type scale: 1, strongly disagree; 6, strongly agree) regarding whether pharmacy technicians should perform 26 community pharmacy dispensing functions. Chi-square difference tests and separate group exploratory factor analyses (EFAs) were conducted. RESULTS: Pharmacists (n = 383) and technicians (n = 579) agreed that technicians should perform 17 of the 26 (65%) functions. The groups differed significantly on eight items that were focused on patient care and beyond technicians' traditional involvement in processing prescriptions, with technicians having a more expansive view of their roles than did pharmacist respondents. Three similar factors were extracted in both groups from the EFAs: functions typical of pharmacy technicians in current practice, clinical pharmacy knowledge functions, and pharmacist-only functions as specified by law. Additionally, general drug knowledge (technician data only) and pharmacy information evaluation and management skills (pharmacist data only) factors were generated. CONCLUSION: Generally, pharmacists and technicians agreed on basic functions involving prescription and claims processing; however, technicians, as compared with pharmacists, supported a more expanded patient care role for themselves.

A pharmacist model of perceived responsibility for drug therapy outcomes.

Pharmacists in community and ambulatory care settings are in a unique position to reduce drug-related morbidity and to optimize patient outcomes by identifying, resolving, and preventing drug therapy problems. This particular approach to pharmacy practice expands traditional pharmacist responsibilities of dispensing pharmaceuticals and providing drug information to optimizing patients' drug therapy outcomes. However, pharmacists in general, and community pharmacists in particular, have yet to incorporate this expanded professional role into daily practice. The objective of this study was to examine the validity of a pharmacist model of perceived responsibility for drug therapy outcomes based on the triangle model of responsibility. A survey instrument was tested among community and ambulatory care pharmacists in Florida, USA. The survey instrument contained the following pharmacist-related constructs from the model: clarity of standards, personal control, professional duty, and perceived responsibility for drug therapy outcomes. The model was examined by testing hypothesized relationships between the model constructs and pharmacists' reports of providing pharmaceutical care. The survey response rate was 40.9% (525/1283). All of the study measures exhibited Cronbach alpha values greater than .70. A measurement model was tested using confirmatory factor analysis. The chi2/df ratio (3.02), CFI (.95), and residual (.051) indicated a good fit of the item data to the constructs. According to path analysis, clarity of standards, personal control, and professional duty were significantly related to perceived responsibility for drug therapy outcomes, which in turn, was significantly related to pharmaceutical care provision. Perceived responsibility for drug therapy outcomes acted as a mediator of the effects of clarity of standards, personal control, and professional duty on pharmaceutical care provision. These findings have implications for pharmacy practice and research.

Predicting physician guideline compliance: an assessment of motivators and perceived barriers.

BACKGROUND: Although clinical practice guidelines are widely accepted as "best practices," provider compliance remains low. OBJECTIVES: To examine the relationship between providers' behavioral intentions and their compliance with practice guidelines; to assess the impact of perceived barriers that were most inhibiting to compliance; and to examine the ability of factors in the Physician Guideline Compliance Model to predict intention to comply and compliance with guidelines implemented at specific practice sites. METHODS: Survey research methods were used to assess effects of antecedents (attitudes, subjective norms, past behavior, and perceived behavioral control) on providers' intentions to comply and compliance with clinical practice guidelines. Provider survey I was conducted at the time of guideline introduction and survey II 4 months after implementation. RESULTS: Scores for the antecedents to behavior and behavioral intention reflected favorable responses toward the use of guidelines. The mean self-reported compliance behavior was 65%, whereas compliance as assessed by chart review was 54%. Approximately 68% of the variance in the physicians' behavioral intentions was accounted for by variables included in the Physician Guideline Compliance Model. A significant negative correlation was found between perceived barriers and self-reported behavior but not between perceived barriers and chart-review-assessed behavior. CONCLUSIONS: Some variables, particularly perceived barriers to guideline implementation, predicted a provider's practice intentions and self-reported behavior. Future guideline intervention efforts should identify and reduce these barriers to guideline compliance prior to implementation.

Influence of explanatory and confounding variables on HRQoL after controlling for measurement bias and response shift in measurement.

The purpose of this study was to examine the influence of explanatory and confounding variables on health-related quality of life after accounting for response shift, measurement bias and response shift in measurement using structural equation modeling. Hypertensive patients with coronary artery disease randomized to anti-hypertensive treatment, completed the ShortForm-36 questionnaire at both baseline and 1 year (n = 788). Three measurement biases were found and all three were considered as response shift in measurement. Older patients reported worse scores for both physical functioning (PF) and role-physical at baseline and 1 year later compared to younger patients; and males reported better PF than females after conditioning on the latent trait of general physical health. Before controlling for response shift, patients' PF scores were not statistically different over time; however, PF scores significantly improved (p < 0.01) after controlling for recalibration response shift. Assessment of how patients perceive their change in health-related quality of life over time is warranted.

Factors associated with the publication of scholarly articles by pharmacists.

PURPOSE: Factors associated with the publication of scholarly articles by pharmacists were evaluated. METHODS: A Web-based survey was distributed to all pharmacists who published at least one scholarly article in selected pharmacy and medical journals in 2008. All scholarly works published in the American Journal of Health-System Pharmacy, Annals of Pharmacotherapy, and Pharmacotherapy during the study period were categorized by study design using a predetermined algorithm. A secondary group of pharmacists who published in at least 1 of 10 selected medical journals during the study period was also evaluated to identify any differences between those who published in pharmacy versus medical journals. RESULTS: The final number of usable responses was 254, for an adjusted response rate of 72.9%. Factors identified as the most helpful for facilitating publication efforts included time allotment, mentorship, and collaborative efforts. "Lack of time" was reported as the most important barrier to publication. The majority of respondents (73%, n = 182) published their first article during a training program (academic program, residency, or fellowship). Of the 468 scholarly works published in the selected pharmacy journals during the study period, review articles were most common (38.7%, n = 177). CONCLUSION: The most influential factors on the publication efforts by pharmacists were time allotment, collaboration between pharmacy colleagues and within multidisciplinary teams, and training in research methods and scientific writing. Introduction to the publication process during training programs appeared to influence future propensity toward scholarly participation. Review and descriptive articles were the most frequently published types of articles in the pharmacy literature.

Evaluation of consumer medication information dispensed in retail pharmacies.

BACKGROUND: United States retail pharmacies are key sources of written consumer medication information (CMI) through leaflets dispensed with prescription drugs. The content and format of this CMI are unregulated. Public Law 104-180 stipulates that by 2006, 95% of prescriptions be accompanied by "useful" CMI. METHODS: Professional shoppers filled prescriptions for lisinopril and metformin in a national sample of 365 pharmacies. Dispensed CMI was evaluated according to explicit criteria (77 for lisinopril and 78 for metformin) adapted from Food and Drug Administration guidelines. RESULTS: Six percent of pharmacies did not provide any written CMI. A mean (SD) of 60.2% (20.7%) and 57.7% (20.1%) of the criteria for useful CMI were met for lisinopril and metformin prescriptions, respectively. Shortcomings concerned especially "directions about use" with means of 53.4% (95% confidence interval [CI], 51.4%-56.5%) and 45.6% (43.7%-47.6%), and "comprehensibility/legibility," with means of 43.8% (42.6%-44.9%) and 42.6% (41.1%-43.7%) for lisinopril and metformin, respectively. The CMI leaflets ranged from 33 to 2482 words, with more than 1000-word differences among those meeting higher than 80% of the content criteria, suggesting large variations in conciseness. Chain pharmacies had better adherence to content criteria than did independent stores, with mean differences of 22.1% (95% CI, 15.8%-28.4%) for lisinopril and 21.1% (95% CI, 14.9%-27.3%) for metformin. CONCLUSIONS: Although distribution through pharmacies seems effective, the content, format, reading level, and excessive length of CMI are disconcerting. Private sector initiatives to provide useful CMI have failed. Research is needed on effective information selection and presentation in terms of effects on comprehension, retention, and appropriate patient actions to derive optimal drug benefit.

Validity and reliability of measurement instruments used in research.

PURPOSE: Issues related to the validity and reliability of measurement instruments used in research are reviewed. SUMMARY: Key indicators of the quality of a measuring instrument are the reliability and validity of the measures. The process of developing and validating an instrument is in large part focused on reducing error in the measurement process. Reliability estimates evaluate the stability of measures, internal consistency of measurement instruments, and interrater reliability of instrument scores. Validity is the extent to which the interpretations of the results of a test are warranted, which depends on the particular use the test is intended to serve. The responsiveness of the measure to change is of interest in many of the applications in health care where improvement in outcomes as a result of treatment is a primary goal of research. Several issues may affect the accuracy of data collected, such as those related to self-report and secondary data sources. Self-report of patients or subjects is required for many of the measurements conducted in health care, but self-reports of behavior are particularly subject to problems with social desirability biases. Data that were originally gathered for a different purpose are often used to answer a research question, which can affect the applicability to the study at hand. CONCLUSION: In health care and social science research, many of the variables of interest and outcomes that are important are abstract concepts known as theoretical constructs. Using tests or instruments that are valid and reliable to measure such constructs is a crucial component of research quality.

Communicating with patients: skills assessment in US colleges of pharmacy.

OBJECTIVE: To describe current practices in assessing patient communication skills in US colleges and schools of pharmacy. METHODS: Syllabi and behavioral assessment forms were solicited and key faculty members were interviewed. Forms were analyzed to determine skills most commonly assessed in communication with simulated or role-playing patients. RESULTS: Fifty schools submitted behavioral assessment forms for patient communication skills. Individuals from 47 schools were interviewed. Colleges were found to vary in the way communication skills were assessed. Assessment forms focused more on dispensing a new prescription than monitoring ongoing therapy. Providing information was emphasized more than promoting adherence. Common faculty concerns were lack of continuity and congruence of assessment across the curriculum. CONCLUSIONS: A common understanding of the standards and procedures for determining competence is needed. Experience and assessment activities should be sequenced throughout a program to build competence.

Using interpersonal perception to characterize pharmacists' and patients' perceptions of the benefits of pharmaceutical care.

Pharmacists and patients seem to have divergent beliefs about potential pharmacy services. Patients have reported desiring more from pharmacists, yet pharmacists have cited lack of patient demand as a reason for not providing pharmaceutical care. Pharmacists (N = 147) and patients (N = 151) completed a questionnaire from multiple perspectives using an interpersonal perception approach assessing their perceptions of the benefits of pharmaceutical care. Findings revealed that pharmacists and patients disagreed on the benefits of those services. Further, they misunderstood each other's perceptions of those services. Few significant differences were found between patients who reported receiving additional services from their pharmacist and those who did not. By directly addressing these differences, pharmacists can attempt to improve patients' perceptions of pharmacy services while providing valuable new services.