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

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

PATIENT SATISFACTIONPATIENT SATISFACTION 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

PHARMACY SERVICESPHARMACY SERVICES 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

Mail Order Pharmacy Community Pharmacy Newer type of pharmacy.Newer type of pharmacy.

Patients receive Patients receive medication through mail.medication through mail.

Saves money compared to Saves money compared to community pharmacy.community pharmacy.66

No face to face interaction No face to face interaction between the patient and between the patient and the pharmacist.the pharmacist.

Delay in filling Delay in filling prescriptions.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

HIV/AIDS-Human Immunodeficiency HIV/AIDS-Human Immunodeficiency Virus/Acquired Immunodeficiency SyndromeVirus/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.

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.

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.

Study designStudy designExploratory cross-sectional study using a convenience sample of HIV infected patients.

Received the Institutional Review Board approval from the University of Toledo.

Instrument developmentInstrument developmentSurvey instrument included three sections: “General information”, “Evaluating pharmacy services”, and “Demographic section”.

Patient satisfaction scale developed from Larson and eveloped from Larson and Mackeigan survey. Mackeigan survey. 1414

F:\Midwest\HIV Patient Satisfaction Questionnaire.doc

Study SubjectsStudy SubjectsA 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.

Data CollectionData CollectionSeven 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.

Data analysisData analysisData 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 variability.

At the end of the study period, 178 surveys were returned. The response rate was 90.4%.

Construct ValidityConstruct 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.

Construct ValidityConstruct 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:\Midwest\Factor Analysis Results.doc

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

Reliability and Item Reliability and Item analysisanalysis

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.

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.

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

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.

University of Toledo, Medical Center staff at HIV clinic who helped in administering the survey.

Organizers of the Midwest conference.

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QUESTIONS???QUESTIONS???