Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [141]-150).

Thesis supervisor: Karen B. Farris. Includes bibliographic references (p. 224-237).

OBJECTIVE OF STUDY: The objective of the study was to examine the quality of interactions occurring between pharmacists and clients, the facilitators and barriers shaping the way pharmacists communicate with clients, and the use of client satisfaction ratings as an outcome measure for pharmacist-client communication. METHODS AND MEASURES: Verbal exchanges between consenting pharmacists (n=100) and clients (n=786) were audio-recorded during four-hour, on-site, observation periods. Clients rated their interaction with the pharmacist using an 11-item Client Satisfaction Rating instrument, while pharmacists completed a questionnaire examining the factors predisposing, enabling, and reinforcing their communication with clients. Subsequent to data collection, an expert panel listened to the audiotapes and rated the quality of the interactions using a 9-item Quality of Communication rating scale. FINDINGS: The mean overall expert rating for the pharmacist-client interactions was 4.0 (out of 7), and represented a "satisfactory" rating. Hierarchical multiple regression analysis revealed that the predisposing, enabling and reinforcing variables measured in the Pharmacists' Questionnaire accounted for 19% of the variance in pharmacists' technical quality scores. Client satisfaction ratings and expert ratings of communication quality were modestly correlated (r=0.14; p<0.001). CONCLUSIONS: While the 60% of consultations in this study met or exceeded the mandated communication requirements of pharmacy practice, pharmacists were uniformly weakest in their client assessment skills and in their discussions of medication precautions and non-pharmacologic approaches to symptom management. Most pharmacists in the study reported being highly predisposed to communicating with their clients, but many lacked the reinforcing factors, and to a lesser degree, enabling factors that are considered necessary to sustain quality communication in the workplace. Client satisfaction ratings were positively skewed with little variability, making it difficult to detect a relationship between the expert and client ratings. Reasons why the study was unable to capture more of the variance in its proposed relationships are provided, as well as areas for future research. KEY WORDS: pharmacist-client communication, client satisfaction, quality / Graduate and Postdoctoral Studies / Graduate

No description available.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis (Ph. D.)--West Virginia University, 2008. / Title from document title page. Document formatted into pages; contains x, 179 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 153-164).

Adverse drug reactions (ADRs) are common and should be reported to the CSM, particularly for newly marketed drugs. There is under-reporting of ADRs by doctors. Involving the patient in self-reporting, particularly when initiated by pharmacists is feasible and could help to improve reporting rates. This study investigated a comprehensive checklist questionnaire listed symptoms in all body systems to facilitate patient self-reporting using both established and new 'black triangle' centrally-acting drugs. Symptoms reported were compared to their documentation in medical notes and for new drugs to reports from other sources. A novel classification system for ADRs was developed to take account of the minimal data available and used to evaluate the potential accuracy of symptom attribution by patients. An external comparison of a sample of symptom classifications by an ADR expert was also obtained. The questionnaire was sent to 464 patients prescribed carbamazepine, sodium valproate, trazodone, doxepin and co-proxamol from three participating medical practices in a pilot study. Subsequently, it was sent to all patients (n=2307) prescribed tramadol, fentanyl patch, venlafaxine, nefazodone, citalopram, moclobemide, gabapentin, lamotrigine and topiramate from 79 participating medical practices in Grampian during January-March 1997. The overall response rates were 44.6% (n=207) for the pilot study and 36.3% (n=837) for the main study. The most frequently reported symptoms were: drowsiness for carbamazepine, unusual tiredness for sodium valproate, constipation for co-proxamol, dry mouth for trazodone, doxepin, tramadol, venlafaxine, nefazodone, moclobemide and citalopram, weight gain for gabapentin, loss of memory for lamotrigine, weight loss for topiramate and constipation for fentanyl patch. Overall only 22.4% (522/2330) of symptoms reported by patients were recorded by GPs in the 310 medical notes accessed. In general, common symptoms were reported more frequently by patients than in CSM reports and PEM data. Patients tended to report minor and known ADRs which bothered them, while CSM and PEM reports received were of more severe ADRs. Respondents were more likely to report symptoms (6040/8630,70%) potentially caused by the study drugs than those not to be caused by the study drugs. Moderate agreement (Kappa = 0.4-0.5) was found between expert and researcher classifications of symptom causality. It is suggested that interpretation by pharmacists of patient self-reporting using the checklist questionnaire could result in much higher ADR reporting rates, in particular for new drugs.

Pharmacists as members of health care teams, have a central role to play with respect to medication. The pharmaceutical care and cognitive services which pharmacists are able to provide can help prevent, ameliorate or correct medication-related problems. There are however many barriers to the provision of these services and one of the barriers commonly cited by pharmacists is the lack of remuneration for their expert services. The aim of this study is to ascertain if patients in South Africa are willing to pay for pharmacist-provided services which may reduce medication related problems, and thereby determine the perceived value of the pharmacist-provided services, by patients. The study will also seek to determine factors that influence willingness to pay (WTP), including financial status, gender, race, age and level of education. In addition the perceived value of the pharmacist‘s role in patient care, by third party payers (SA Medical Aid providers) and their WTP for pharmacist-provided services (such as DSM) on behalf of patients through their monthly premiums will also be investigated. The study was conducted as a two-phase process: the first phase focused on the opinions of patients and the second phase on the medical aid companies. In phase-1 a convenience sample of 500 patients was recruited by fifty community pharmacies distributed throughout the nine South African provinces. Data collection, consisting of telephonic administration of the questionnaires, was conducted and the survey responses were captured on a Microsoft Excel® spreadsheet. All the captured information was analyzed using descriptive statistics, box and whisker plots, analysis of variance (ANOVA) and regression analysis. In phase-2, medical aid schemes that are registered with the Council of Medical Schemes (CMSs) of South Africa were included in this research. A fifteen point questionnaire was completed electronically via e-mail by willing medical aid participants. Data was analyzed using descriptive statistics only. Only 233 or 88.6 percent, of the 263 participating respondents, were willing to pay at least one rand towards pharmacist-provided services. On average respondents were willing to pay R126.76 as out-of-pocket expenses. Respondents‘ WTP increased as the risk associated with medication-related problems was reduced due to pharmaceutical care intervention. Of the 263 respondents who took part in this research, fifty percent were willing to pay at least R100 for a risk reduction of 30 percent, R120 for a 60 percent reduction and approximately R150 for a greater than 90 percent risk reduction. It was also found that the respondents‘ willingness to pay was influenced by their age, earnings, racial grouping, employment status, medical aid status and their level of satisfaction with pharmacist-provided care services. Of the thirty-one open medical aid schemes only eight (25.8 percent) participated in the study. Findings indicate that all the participating medical aid respondents were unwilling to pay for pharmacist-provided care services, although they perceived pharmacists as very influential healthcare providers and as having a significant role to play in reducing medication-related problems. In conclusion it was found that majority of participants were willing to pay for pharmacist-provided services directed towards reducing risks associated with medication-related problems. Until pharmacists are able to prove pharmaceutical care‘s utility and cost-effectiveness to third-party payers, pharmacists must look to the patient for reimbursement.

No description available.

This study used the Andersen Model for Health Services Utilization to examine a pharmacist-provided telephone MTM program among Medicare Part D beneficiaries. Predisposing (age, gender, race) and need factors (number of medications, number of chronic diseases, medication regimen complexity) were assessed. The health behavior, MTM utilization, distinguished the intervention and control groups. The health outcomes were change in number of medication-related problems, change in medication adherence [using the medication possession ratio (MPR)], and change in total drug costs. Medication knowledge, medication adherence (using the Morisky Scale), and patient satisfaction were also measured in the intervention group. The intervention and control groups were not significantly different in age (71.2 ± 7.5 vs. 73.9 ± 8.0 years), number of medications (13.0 ± 3.2 vs. 13.2 ± 3.4), number of chronic diseases (6.5 ± 2.3 vs. 7.0 ± 2.1), and medication regimen complexity [21.5 (range 8 – 43) vs. 22.8 (range 9 – 42.5)], respectively. For the subset of problems that was evaluated in the intervention and control groups, 4.8 (± 2.7) and 9.2 (± 2.9) problems were identified at baseline and 2.7 (± 2.3) and 8.6 (± 2.9) problems remained at the 3-month follow-up, respectively. Cost-related and preventative care needs and drug-drug interactions were the three most common problems identified. Multivariate regression analysis revealed that the intervention group had significantly more problems resolved (p < 0.0001) when compared to the control group, while controlling for predisposing and need factors. Significantly fewer problems were resolved (p = 0.01) as number of diseases increased and significantly more problems were resolved (p = 0.01) as medication regimen complexity increased. There were no significant predictors of change in MPR or total drug costs from baseline to the 3-month follow-up. Medication knowledge and medication adherence measured by the Morisky scale did not change significantly from baseline to the 2-week follow-up. However, patients were very satisfied with the service. A pharmacist-provided telephone MTM program was an effective method for identifying and resolving medication and health-related problems. A longer follow-up period may be necessary to detect the impact of pharmacist provision of MTM on adherence, total drug costs, and knowledge. / text