| Objective: The study aimed to develop and optimize a quality evaluation system of pharmaceutical services for chronic diseases in community pharmacies in China.The quality evaluation system was applied to survey the current situation of pharmaceutical services for chronic diseases in community pharmacies in Guangdong Province,in order to find out problems of pharmaceutical services,propose improvements and validate the applicability of the quality evaluation system,thus improve the ability and quality of pharmaceutical services for chronic disease in community pharmacies.Methods: 1.Development of the quality evaluation system of pharmaceutical services for chronic diseases in community pharmacies(version 1.0): Candidate indicators were screened out based on literature research and situations in China,and the indicators were divided into three categories: structure,process and outcome.Delphi method was used to collect opinions of experts from community pharmacy,hospital pharmacy,college/university of pharmacy,drug regulatory administration and pharmacist association.If the consensus frequency was ≥75%,the median≥4.00,and the IQR score was at a medium level of consensus and above,the indicator was finally included in the quality evaluation system.2.Optimization of the quality evaluation system of pharmaceutical services for chronic diseases in community pharmacies(version 2.0): First,focus group interviews were conducted with experienced pharmacists from a retail chain community pharmacy in Guangdong Province to determine and improve the clarity of indicators.Second,questionnaire survey among the pharmacists in retail chain community pharmacies in Guangdong Province was made to determine the content validity and feasibility of the indicators.Quality indicator would be included if the description of the indicator was clear and independent,content validity index(CVI)and feasibility index(FI)of the indicator was≥0.78.Weight of the indicator was determined by expert opinion and percentage weight method.3.Investigation on the current situation of pharmaceutical services for chronic disease in community pharmacies in Guangdong Province: The quality evaluation system version 2.0 was used to survey the current situation of three large retail chain community pharmacies in Guangdong Province and validate the applicability of the quality evaluation system.Descriptive statistics were used to analyze the results.Results: 1.Development of the quality evaluation system of pharmaceutical services for chronic diseases in community pharmacies(version 1.0): 46 candidate indicators were initially selected through literature research.15 experts participated in the Delphi survey to evaluate the quality indicators.6 candidate indicators were deleted and 8 indicators were added based on expert opinions.The quality evaluation system version 1.0 included 48 indicators: 17 structure indicators,16 process indicators,and 15 outcome indicators.Weigh for first-level indicators were 0.4457,0.2864 and 0.2679 for process,structure and outcome respectively.2.Optimization of the quality evaluation system of pharmaceutical services for chronic diseases in community pharmacies(version 2.0): Seven experienced pharmacists from a large retail chain community pharmacy in Guangdong Province participated in the focus group interview.316 pharmacists participated in the survey to evaluate content validity of the indicators.135 pharmacists also evaluated the feasibility of the indicators.According to the results of focus group interviews,14 indicators were revised and 2 indicators were deleted.Based on the evaluation of content validity and feasibility,2indicators were deleted including reduction of drug treatment costs(indicator 42)and reduction of readmission rate(indicator 37).The optimized quality evaluation system version 2.0 contained 44 indicators.In terms of second-level weight for indicator,weight for structure indicators were0.0160～0.0177;weight for process indicators were 0.0248～0.0312;weight for outcome indicators were 0.0222～0.0254.3.Investigation on the current situation of pharmaceutical services for chronic disease in community pharmacies in Guangdong Province: A total of 227 community pharmacies were included in the evaluation of the quality of pharmaceutical services for chronic diseases.The results showed that the main types of chronic diseases covered by pharmaceutical services were hypertension(99.55%),diabetes(97.77%)and hyperlipidemia(77.23%).Most community pharmacies were equipped with the necessary facilities to provide pharmaceutical services for chronic diseases,and chronic disease pharmacists were mainly licensed pharmacists with junior college degree.In terms of service process,with the exception of the five core elements of Medication therapy management(MTM),the rest of the process indicators had been completed well.In terms of service outcome,about 25% community pharmacies have not evaluated service effectiveness.The community pharmacies that have evaluated the service effectiveness mainly improved patient satisfaction,adherence and medication awareness.Pharmacist’s evaluation of quality of pharmaceutical services for chronic disease showed that,structure-quality were better than those related to process and outcome.Community pharmacists generally accepted the quality evaluation system version 2.0,but they suggested that the system should be simplified further.Conclusion: 1.Based on the structure-process-outcome model,the study developed a quality evaluation system of pharmaceutical services for chronic diseases in community pharmacies in China,which had good content validity and feasibility.The system was suitable for both internal self-evaluation initiated by community pharmacies and external evaluation initiated by a third party.2.The status survey applying the quality evaluation system version 2.0 showed that retail chain community pharmacies in Guangdong Province have had infrastructure and personnel to provide pharmaceutical services for chronic disease,but the process and outcome of pharmaceutical services should be improved,especially knowledge and skills of pharmacists to implement medication therapy management(MTM),recording and evaluation of outcome of pharmaceutical services.In addition,the quality system version 2.0 was widely accepted by community pharmacists who participated in the survey. |
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