Developing and testing a set of quality indicators for pharmacist home visit services: A mixed methods study in Japan

Abstract

Objective: Quality indicators (QIs) are an important mechanism by which health services can be evaluated. We aimed to develop a set of QIs for pharmacist home visit services and assess their measurement properties. Methods: A three-step procedure was applied: (1) Selection of existing contentvalidated QIs from the international literature and the development of QIs based on national guidelines and home healthcare professionals' opinions; (2) Expert panel consensus of a preliminary set of QIs using the RAND/UCLA Appropriateness Method; (3) Field testing to evaluate their measurement properties (feasibility, applicability, improvement potential, discriminatory capacity, sensitivity to change, acceptability and implementation issues) followed by exploratory semistructured interviews in Japan. Results: Fifty-two preliminary QIs were prepared and 45 were judged as "appropriate"by the expert panel. Sixty-one community pharmacies were recruited to this study with 41 contributing QI data monthly over the 6-month period. Field testing showed that 20 QIs met six measurement properties (ie, feasibility, applicability, improvement potential, discriminatory capacity, acceptability and implementation issues). Nine of these QIs also had high sensitivity to change. Additionally, interviews identified that the main positive impact on practice of using QIs was the early detection of causes of drug-related problems but a negative impact was decrease of pharmacists' motivation. Auto extraction of QIs was seen as a major facilitator, given the time taken to manually extract QI data. Conclusions: A set of QIs for pharmacist home visit services was rigorously developed and tested. This QI set may be useful in evaluating the quality of such services.

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

“…QIs are a recognized mechanism for improving quality use of medicines if they have been robustly developed and their measurement properties scientifically tested. 55 QIs are measurable elements of practice performance for which there is evidence or consensus that it can be used to assess the quality, and hence change in the quality, of care provided. 56 QIs are usually described with a denominator and a numerator.…”

Validation of quality indicators for evaluating geriatric pharmacotherapy services in primary care: a mixed methods study

“…A previous validation study on QIs for pharmacist home visit services showed that 73% of the QI set (29/40) had room for improvement, indicating that the quality of home healthcare services might be higher than the quality of geriatric primary care. 23 In fact, a previous study reported that home care allows for a deeper relationship with the patient than outpatient care, and as a result, higher quality of care could be provided. 36 Given the transition of older people from primary care to home care, it is important to longitudinally evaluate quality of care for them using both QIs.…”

“…All interviews were conducted by NS (a female pharmacist and researcher with training and experience in qualitative research) in Japanese via Zoom following a semistructured interview guide and audio-recorded with notes taken during interviews (see online supplemental appendix 3 ). 23 Interviews were continued until three consecutive interviews provided no additional themes (ie, data saturation). 31 Before ending each interview, interviewees were allowed to provide any further comments.…”

“…A sample size of 50 pharmacies was estimated to allow for sufficient diversity in terms of location (eg, urban and rural) and ownership (eg, chain and independent). 23 A kick-off meeting was held on 11 February 2020 to train community pharmacists Open access in the study protocol. During the meeting, one moderator (KF) explained the concept of measuring quality of care using QIs and another moderator (NS) provided information on the study protocol and the way of data collection.…”

Development and consensus testing of quality indicators for geriatric pharmacotherapy in primary care using a modified Delphi study

“…Panellists judged the face and content validity of each QI, using a 9–point scale (ranging from 1 “definitely not appropriate” to 9 “definitely appropriate”) with an opportunity to provide suggestions or modifications via SurveyMonkey™ . This study defined appropriateness as “whether care described in the QIs must be provided in principle” and “whether a high QI score would be interpreted as a high–quality care” [ 33 ]. A QI with a median score of 7–9, without disagreement (i.e.…”