Developing anchored measures of patient satisfaction with pharmaceutical care delivery: Experiences versus expectations

Rosemin Kassam1, John B Collins2, Jonathan Berkowitz31Structured Practice Education Program, Faculty of Pharmaceutical Sciences; 2Department of Educational Studies; 3Sauder School of Business, University of British Columbia, Vancouver, BC, CanadaBackground: A pilot study was undertaken to evaluate patients’ satisfaction with pharmaceutical care (PC) activities delivered at community pharmacies. The objectives of the study were to: (1) operationalize patient satisfaction in terms of the advanced pharmacy practice experience (APPE) PC activities, (2) conduct psychometric analysis of the satisfaction instrument, and (3) assess the sensitivity of the instrument to detect any differences that may exist between what patients expect to receive versus what is actually experienced.Methods: Pharmacies affiliated with two national chains were recruited to participate. Asthma patients at each of these sites were invited to complete a survey designed to assess their expectations of and their experiences with PC at the respective site.Results: One hundred forty-seven surveys were completed from patients in 19 community pharmacies. Psychometric analysis confirmed the survey’s internal reliability and sensitivity to be very high. Data analysis suggested that most patients expect more from PC services than they actually experienced.Conclusion: Unlike other PC satisfaction surveys, this instrument allows patient experiences to be anchored against their expectations. The results suggest that most patients would be willing to engage in PC activities outlined in the survey.Keywords: satisfaction survey, pharmaceutical care, community-APP

Out-of- school time use in Pakistan: A qualitative study featuring youth\u27s voices

The current study addresses the lack of out-of-school time (OST) research in low- and middle-income countries by exploring OST use in the context of Pakistan and incorporating youth\u27s voices. Using a qualitative descriptive design with focus-group discussions, we conducted a study in three middle schools set in low- to middle-income neighborhoods in urban and rural areas of Karachi, Pakistan. We engaged 86 youth (50% girls; aged 10–15 years) that were purposefully selected from grade six (31.4%), seven (44.2%) and eight (24.4%) classrooms, balancing gender and locality. In each focus group, we asked participants to describe their afterschool activity routine on a typical weekday afternoon until bedtime. Digital recordings of discussions were transcribed verbatim and analyzed using content analysis. Based on sixteen focus groups with five to six participants in each group, we identified eight distinct categories: religious activities, schoolwork, screentime, helping adult family members, family time, outdoor play, indoor leisure activities, and hanging out with friends. We found that structured activities (e.g., religious activities and schoolwork supervised by an adult) were reported more frequently than unstructured activities (e.g., outdoor play and family time). Participation in activities varied by gender and location (i.e., urban vs. rural), highlighting disparities associated with the sociocultural context that marginalized youth face. Our findings provide a glimpse into the everyday lives of Pakistani youth outside of school. Additionally, they elucidate how economic resources, sociocultural norms regarding gender, and community safety shape youth\u27s time use and socialization patterns. Findings from this study can inform the development of OST activities and initiatives aimed at promoting the positive development of Pakistani youth

Caregivers’ Treatment-Seeking Behaviors for Malaria in Children Five and Under: A Field Study in Uganda’s Butaleja District

Background: Reducing malaria mortality is a global priority. Uganda has focused its national strategic plan to have by 2010: 85% of children under five receive first-line antimalarials within 24 hours of fever onset and following diagnostic confirmation. In 2004, artemisinin-combination therapies (ACTs) were adopted as first-line treatment for uncomplicated malaria in children older than 4-months. Method: A three-study series investigated caregivers’ malaria related treatment-seeking behaviors for young children to inform future public health initiatives in Uganda’s Butaleja District: a literature review, a household survey, and a multiple case study. In this document, these appear as three manuscripts in Chapters 2-4. Results: While drug delivery improvements have increased ACT usage, these studies concur that initiatives still failed to meet the 2010 national target. Only 21% of children received blood tests, 31.6% received no antimalarials, 31.6% received “appropriate” (only first-line) antimalarials, and 36.8% received subordinate antimalarials. Among subordinates, 5.8% of children were mis-prescribed ACTs and 22.4% received ACTs and subordinate antimalarials. Home management was an important initial treatment source since visits to public facilities were commonly associated with hardships. Caregivers’ knowledge and preference about antimalarials varied with prior experiences and beliefs. The survey evaluated 160 behavioral questions in determining four independent predictors of likelihood that a child would receive an “appropriate” antimalarial: obtaining antimalarials from regulated outlets (OR=14.99); keeping ACT in the home for future use (OR=6.36); reporting they would select ACT given the choice (OR=2.31); and child’s age older than 4 months (OR=5.67). The study further employed the Health Belief Model to identify 10 scales of “Assets” and “Challenges” to guide more precise insights into caregivers’ behaviors. Four “Asset” scales predicted significantly whether a child received an “appropriate” antimalarial: Precursors to Receiving an Appropriate Antimalarial (R2=21%); Episode Management (R2=39%); Caregiver Knowledge (R2=6%); and Professional Assistance with Critical Decision (R2=9%). Similarly, two “Challenge” scales were significant predictors: Lack of Assistance with Critical Decision (R2=9%), and Problems Obtaining a Best Antimalarial (R2=4%).Conclusions: To conform practice to policy, this research sequence highlighted the importance of engaging the full spectrum of stakeholders in public health initiatives to manage malaria, including licensed and unlicensed providers, caregivers and family members

Understanding Unlicensed Drug Vendor Practices Related to Childhood Malaria in One Rural District of Uganda: An Exploratory Study

This study investigated unlicensed drug outlets’ practices for the management of malaria in the rural district of Butaleja, Uganda. A qualitative design using semistructured interviews was used. Interviews were recorded, translated, transcribed, and analyzed using thematic analysis. A total of 75 vendors, representing 85% of the outlets in the study area, were interviewed. Most of the vendors were associated with a drug shop type of outfit. About three-quarters reported having completed some level of postsecondary education, but just one-tenth of the vendors had qualifications that made them eligible to apply for a license to operate a drug shop. While most outlets stocked at least one type of antimalarial, only about one-quarter stocked an artemisinin-based combination therapy (ACT), one-quarter expressed a preference for ACTs, and less than one-tenth attested to firmly adhering to the national malaria treatment guidelines on dispensing ACTs as the first-line option. In contrast, nine out of 10 vendors stocked quinine and well over a third stocked antimalarials no longer recommended, such as chloroquine and sulphadoxine-pyrimethamine. Given the ongoing gap between the national malaria policy and unlicensed drug outlet practices, this study calls for greater engagement of unlicensed vendors to improve the management of childhood malaria

Assets and challenges facing caregivers when managing malaria in young children in rural Uganda

Background: Despite efforts to improve malaria management for children, a substantial gap remains between policy and practice in Uganda. The aim of this study was to create quantitative profiles of assets and challenges facing caregivers in Butaleja District when managing malaria in children aged 5 years and under. The objectives were: (1) to estimate caregivers’ assets and challenges during an acute episode; and, (2) to ascertain which caregiver attributes influenced receipt of an appropriate anti-malarial the most. Methods Data from a 2011 cross-sectional, household survey and ten psychometrically justified scales were used to estimate caregivers’ assets and challenges. The scales scores were simple counts across a series of items, for example, the number of times a caregiver answered a knowledge item correctly or the number of times a caregiver relied on a credible source for information. Since high scores on six of the scales reflected attributes that eased the burden of caregiving, these were labelled ‘caregiver assets’. Similarly, high scores on four of the measures signalled that a caregiver was having trouble managing the malaria episode, thereby reflecting deficits, and these were labelled ‘caregiver challenges’. ANOVAs were used to compare scale scores between caregivers of children who received an appropriate anti-malarial versus those who did not. Results On the six asset scales, caregivers averaged highest on knowledge (65 %), followed by correct episode management (48 %), use of trustworthy information sources (40 %), ability to initiate or redirect their child’s treatment (37 %), and lowest on possible encounters with health professionals to assist in treatment decisions (33 %). Similarly, the average caregiver reported problems with 74 % of the issues they might encounter in accessing advice, and 56 % of the problems in obtaining the best anti-malarial. Caregivers whose children received an appropriate anti-malarial demonstrated greater assets and fewer challenges than those whose child did not, with important regional differences existing. Overall, no one region performed particularly well across all ten scales. Conclusions Findings from this study suggest that the low use of artemisinin-based combination therapy (ACT) in Butaleja for children 5 years and under may result from caregivers’ high perceived barrier to accessing ACT and low perceived benefits from ACT.Education, Faculty ofMedicine, Faculty ofNon UBCEducational Studies (EDST), Department ofPopulation and Public Health (SPPH), School ofReviewedFacult

Role-Emergent Model: An Effective Strategy to Address Clinical Placement Shortages

Purpose: To evaluate the effectiveness of an advanced pharmacy practice experience (APPE) delivered at “role-emergent” placement sites within long-term care (LTC) facilities that are preceptored by off-site community pharmacists.Method: Seven LTC facilities participated: five newly recruited test sites preceptored by off-site pharmacists who supervised students remotely (“role-emergent” placements), and two previously established hospital-based facilities with on-site pharmacists who provided continuous student supervision (“role-established” placements) as a comparison group. Students participated in pre-APPE training. Both qualitative and quantitative methods were used to obtain student learning performance on 13 pre-defined learning objectives and 21 indicators of site resources and skills-development opportunities. Structured open-ended feedback questions and reflective student observations elicited more personal and situational experiences. These combined with faculty reviews of student documentation of their patient care delivery encounters and LTC Staff perspectives enabled comparisons between the two APPE formats. Results: A total of 23 students participated: three at role-established and 20 at role-emergent sites. Evaluations indicated that all students successfully completed their learning objectives. Some differences were apparent – for example students at role-emergent sites expressed a desire for more one-to-one time with their pharmacy preceptor, but they also benefitted from more inter-professional collaboration and interacted with a broader range of health professionals than students with on-site APPE preceptors. Conclusions: This study demonstrated that equivalent but non-identical learning occurs at LTC locations with off-site preceptors (role-emergent) as in role-established hospital-based settings with on-site preceptors. Importantly, it also opens opportunities for many new APPE placement opportunities since there about three times as many LTC facilities as acute care hospitals in our jurisdiction