Development of Patient-reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL): A novel instrument for medication management

Impact of pharmacist-led pharmaceutical care on health-related and pharmaceutical therapy-related quality of life in patients with heart failure: A randomized controlled trial

BACKGROUND

Data on the impact of pharmacist-led pharmaceutical care (PC) on pharmaceutical therapy-related and health-related quality of life (HRQoL) and their sensitivities to PC provision in patients with heart failure (HF) are scarce.

OBJECTIVES

This study aimed to assess the impact of pharmacist-led PC on HRQoL employing the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and 5-level EuroQol 5 dimension (EQ-5D-5L) and on pharmaceutical therapy-related quality of life using the Patient-Reported Outcomes Measure of Pharmaceutical Therapy (PROMPT) in HF patients and compare sensitivities to the PC provision of these three tools.

METHODS

A single-blinded randomized controlled trial was conducted at a tertiary public hospital in Thailand between November 2022 and May 2023. Overall, 250 patients were randomly divided into the usual care (UC) (N = 124) and PC (N = 126) groups. Mixed effects models were used to investigate the differences in the mean change scores of PROMPT, EQ-5D-5L, and MLHFQ between the UC and PC groups. The sensitivities to PC provision of the three measures were evaluated using standardized effect sizes (SESs).

RESULTS

Significant differences were found in five of eight domains and the total score of the PROMPT between the PC and UC groups (all p < 0.05). However, no significant differences were found in the EQ-5D-5L and MLHFQ between the two groups (both p > 0.05). The SESs of the five domains and total score of PROMPT ranged from 0.29 to 1.65, considered small-to-large effect sizes, whereas the SESs of EQ-5D-5L and MLHFQ were -0.4 to 0, considered small effect sizes.

CONCLUSIONS

Pharmacist-led PC can positively affect pharmaceutical therapy-related quality of life using PROMPT in HF patients. Additionally, PROMPT is more sensitive to PC provision than EQ-5D-5L and MLHFQ.

The association between medication use and health-related quality of life in multimorbid older patients with polypharmacy

PURPOSE

To explore the association between medication use-related factors and health-related quality of life (HRQoL) in older hospitalised multimorbid patients with polypharmacy.

METHODS

This cross-sectional study used the intervention arm data of the OPERAM trial (hospitalised patients ≥ 70 years with polypharmacy). HRQoL was assessed using the visual analogue scale (EQ-VAS) and the EQ-5D index score of the EuroQol questionnaire (EQ-5D-5L). Lower or higher EQ-VAS/EQ-5D was based on the median of the study population. Medication use-related factors included hyperpolypharmacy (≥ 10 medications), anticholinergic and sedative burden, appropriateness of medication (STOPP/START criteria), high-risk medication for hospital (re)admission, medication complexity and adherence. Multivariable logistic regression analysis was used to assess the association between medication use-related factors and HRQoL.

RESULTS

A total of 955 patients were included (mean age 79 years, 46% female, median EQ-VAS of 60, median EQ-5D of 0.60). Opioids use was associated with lower EQ-5D and EQ-VAS (aOR EQ-5D: 2.10; 95% CI 1.34-3.32, EQ-VAS: 1.59; 1.11-2.30). Hyperpolypharmacy (aOR 1.37; 1.05-1.80), antibiotics (aOR 1.64; 1.01-2.68) and high medication complexity (aOR 1.53; 1.10-2.15) were associated with lower EQ-VAS. A high anticholinergic and sedative burden (aOR 1.73; 1.11-2.69), presence of multiple prescribing omissions (aOR 1.94; 1.19-3.17) and benzodiazepine use (aOR 2.01; 1.22-3.35) were associated with lower EQ-5D. Especially in hyperpolypharmacy patients, high anticholinergic and sedative burden and medication complexity were associated with a lower HRQoL.

CONCLUSION

Several medication use-related factors are significantly associated with a lower HRQoL in hospitalised older patients. Medication complexity is a novel factor, which should be considered when evaluating medication use of older patients with hyperpolypharmacy.

Comparison of the sensitivities of pharmacotherapy-related and disease-specific quality of life measures in response to pharmacist-led pharmaceutical care for cancer outpatients: a randomised controlled trial

BACKGROUND

No data were previously available regarding the sensitivities of pharmacotherapy-related and disease-specific quality of life measures to pharmacist-led pharmaceutical care (PC).

AIM

The aim was to compare the sensitivities of two health-related quality of life (HRQoL) measures, i.e. the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) versus the Functional Assessment of Cancer Therapy-General (FACT-G), in response to pharmacist-led PC for cancer outpatients.

METHOD

A randomised controlled trial was conducted on cancer outpatients of a tertiary Thai hospital. Eligible patients were randomly allocated to a PC group receiving PC interventions or a usual care (UC) group receiving pharmacist's standard care. The HRQoL of both groups was assessed using the PROMPT-QoL and the FACT-G before and after intervention. The sensitivities of the two measures were determined using standardised mean differences (SMDs).

RESULTS

A total of 237 patients in two arms (120 PC vs. 117 UC patients) completed the trial. With PC interventions, all eight PROMPT-QoL domains and 3 out of 4 FACT-G domains were significantly improved. The PROMPT-QoL yielded SMDs ranging from 0.24 to 1.68 that were considered moderate-to-high sensitivity, while the FACT-G provided moderate sensitivity with SMDs of 0.31-0.64. The average SMDs of four FACT-G domains was 0.50 and SMD of the total score was 0.80. Eight PROMPT-QoL domains had the average SMD of 0.60 and the total score SMD was 1.40.

CONCLUSION

The PROMPT-QoL is more sensitive to detect HRQoL when delivering pharmacist-led pharmaceutical care to cancer outpatients.

TRIAL REGISTRATION

TCTR20210809008.

Factors associated with patient experiences of the burden of using medicines and health-related quality of life: A cross-sectional study

Objective

Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern globally. This study aimed to identify the significant factors that predict the perceived burden of medication and health-related quality of life.

Methods

Adults, aged 18 years and above who have used at least two regular medicines, were invited to complete the study questionnaires between June and October 2019. Multiple linear regression analysis was conducted to identify significant predictors for perceived burden of medication and health-related quality of life.

Results

A total of 119 participants completed this study. The average age of the participants was 63 years (SD±16 years). Factors significantly predicting perceived burden of medication were participants’ current health condition (p = 0.001), overall burden of treatment (p<0.001) and being hypertensive (p = 0.037). Similarly, participants’ current health condition (p<0.001) and overall burden of treatment (p = 0.086) were significant predictors for perceived health-related quality of life.

Conclusions

This study revealed that hypertensive participants in poor health tended to experience higher perceived burden of medication, which in turn was found to be correlated with lower perceived health-related quality of life.

Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital

Introduction

Drug-related problems could potentially worsen the clinical outcomes in critically ill patients. Critically ill patients are generally considered more vulnerable to harm from drug-related problems due to frequent medication-related events and complicated clinical courses. However, drug-related problems identified by on-ward clinical pharmacists in medical intensive care units in Thailand are not well reported. This study reports clinically relevant data with the description of identified problems, common causes of drug-related problems, and pharmacists' interventions performed in real world, so that it may serve as an educational material for pharmacists who implement a pharmaceutical care and participate in medical intensive care units.

Methods

A retrospective descriptive study was conducted at a tertiary university hospital in Bangkok, Thailand, from January 2015 to December 2020. The drug-related problems were categorized according to Cipolle et al.'s classification. The severity of drug-related problems in this study was rated by modifying the definition of The National Coordinating Council for Medication Error Reporting and Prevention Taxonomy of Medication Error to report harm from drug-related problem-related patient outcomes.

Results

A total of 698 drug-related problems were detected in 374 critically ill patients. The prevalence of drug-related problems occurring in critically ill patients admitted to the medical intensive care unit was 73.9%. The most frequent drug-related problems were dosage too high (27.7%), ineffective drug (17.2%), need for additional drug therapy (15.3%), unnecessary drug therapy (14.6%), dosage too low (14.3%), adverse drug reaction (9.7%), and non-adherence (1.2%). The severity of drug-related problems in the medical intensive care unit was assessed as a drug-related problem with no harm (78.2%). Pharmacists' interventions were advised according to drug-related problem identification to provide personalized pharmacotherapy optimization in critically ill patients.

Conclusion

The most frequent drug-related problem identified during pharmaceutical care interventions in the medical intensive care unit at tertiary university hospital is dosage too high. The severity of drug-related problems is mostly determined as drug-related problems with no harm.

Impact of a drug-related patient-reported outcome measure on drug-related problem identification, physicians' acceptance, and clinical and quality of life outcomes: a randomized controlled trial

BACKGROUND

Data are scarce regarding the usefulness of a pharmaceutical therapy-related quality of life measure including the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL), for providing pharmaceutical care.

AIM

To evaluate the impact of the PROMPT-QoL on identifying drug-related problems (DRPs), physicians' acceptance of pharmacist's recommendations on the DRP resolution, and clinical and quality of life outcomes.

METHOD

A single-blind randomized controlled trial was conducted at a tertiary public hospital in Thailand from October 2019 to May 2020. A total of 286 outpatients with chronic diseases were randomly allocated into the control group (provided with pharmaceutical care only) (N = 146) and the intervention group (provided with pharmaceutical care together with use of the PROMPT-QoL) (N = 140).

RESULTS

A significantly higher mean number of DRPs could be identified in the intervention group than in the control group (p < 0.001). Moreover, there was a significantly higher proportion of physicians' acceptance of pharmacist's recommendations on the DRP resolution in the intervention than in the control group (p = 0.019). Regarding the clinical outcome, a significantly higher proportion of the DRP resolution was found in the intervention group than in the control group (p = 0.002). For quality of life outcomes, the intervention group yielded a significantly higher mean difference between posttest and pretest on the Medicine and Disease Information domain score of the PROMPT-QoL (p = 0.029) and the EuroQoL-Visual Analog Scale score (p = 0.031) than the control group.

CONCLUSION

This study revealed that the application of the PROMPT-QoL together with pharmaceutical care favorably influenced identification of DRPs, physicians' acceptances, and clinical outcomes. Trial registration TCTR20201208005 on December 5, 2020.

Factors Associated with Medication-Related Burden Quality of Life (MRB-QoL) in Community-Dwelling Adults with Long-Term Conditions: An Exploratory Study

Background

The Medication-Related Burden Quality of Life (MRB-QoL) tool has been developed to measure the burden of medications on functioning and wellbeing from a patient perspective. However, predictors of MRB-QoL were not reported in greater detail in the validation study. This study aimed to explore factors associated with MRB-QoL to see whether there is any new information that calls for further research.

Methods

Analysis of data from the MRB-QoL validation study was undertaken. Outcome variables were domains of the MRB-QoL (Routine and Regimen Complexity, Psychological Burden, Functional and Role Limitation, Therapeutic Relationship, and Social Burden). Explanatory variables were patient age; disease-related factors; and medication-related factors, such as number of medications, complexity of medication regimen (measured by the Medication Regimen Complexity Index [MRCI]), and exposure to medications with anticholinergic and sedative effects (measured by the Drug Burden Index [DBI]). Linear regression analyses were used to identify factors associated with the MRB-QoL.

Results

The study included 367 participants (52.1% male), with a median age of 64 years. In multivariable regression analyses, an increase in the DBI was significantly associated with poorer Psychological wellbeing (β=−0.15, p<0.001) and Functional and Role Limitation (β=−1.79, p<0.001). Living with three or more medical conditions was significantly associated with poorer Psychological wellbeing (β=−0.21, p<0.001). Age was significantly associated with all domains of the MRB-QoL (β=0.28 to 0.55). Polypharmacy and MRCI were not associated with any of the MRB-QoL domains.

Conclusion

In this sample of community-dwelling adults with multiple medications, the DBI was independently associated with the Psychological Burden and Functional and Role Limitation domains of the MRB-QoL. This study provides preliminary evidence on factors affecting medication-related quality of life outcomes from a patient perspective. Future longitudinal studies, along with further psychometric testing of the MRB-QoL measure, are warranted to better understand predictors of MRB-QoL.

Medication-Related Quality of Life in Thai Epilepsy Patients

Background and Purpose

This study aimed to assess medication-related quality of life in Thai patients with epilepsy. The second objective was to evaluate the associations between the medication therapy-related quality of life and patient characteristics.

Methods

This was a cross-sectional study. A convenience sample of 173 outpatients with epilepsy was recruited from a university hospital in Bangkok, Thailand. Inclusion criteria were aged 18 or over who were continuously taking an epileptic drug for at least 3 months, understanding Thai language, and willing to participate in the study. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to measure the medication therapy-related quality of life. Pearson’s correlation coefficients and stepwise multiple linear regressions were employed to assess the relationships between eight PROMPT-QoL domain scores and patient demographic and clinical characteristics.

Results

Mean age was 36.4±9.5 years and approximately 57% were female. Among eight domains of the PROMPT-QoL, the therapeutic relationships with health care providers and psychological impacts of medication use domains yielded the highest (77.9) and lowest (61.9) mean scores, respectively. Seven out of eight PROMPT-QoL domain scores were considered as moderate-to-good. Age, gender, duration of epilepsy, seizure frequency, and treatment preference were significantly associated with PROMPT-QoL domain scores in multivariate linear regression analyses.

Conclusions

This study showed that Thai patients with epilepsy had moderate-to-good medication therapy-related quality of life. Healthcare providers should pay more attention to patients’ psychological impacts of antiepileptic drugs and those with characteristics related to lower medication therapy-related quality of life.

Practical Barriers to Medication Adherence: What Do Current Self- or Observer-Reported Instruments Assess?

Introduction

Practical adherence barriers (e.g., medication frequency) are generally more amenable to intervention than perceptual barriers (e.g., beliefs). Measures which assess adherence barriers exist, however these tend to measure a mix of factors. There is a need to identify what practical barriers are captured by current measures.

Aim

To identify and synthesise the practical adherence barriers which are assessed by currently available self- or observer-report adherence measures.

Methods

A search for systematic reviews of self- or observer-report report adherence measures was conducted. Three electronic databases (Embase, Ovid Medline, and PsycInfo) were searched using terms based on adherence, adherence barriers and measures. Systematic reviews reporting on adherence measures which included at least one self- or observer-report questionnaire or scale were included. Adherence measures were extracted and coded on whether they addressed perceptual or practical barriers, or both. Practical items were then analysed thematically.

Results

Following screening of 272 initial abstracts, 20 full-text papers were reviewed. Four were excluded after full-text review, leaving 16 systematic reviews for data extraction. From these, 187 different adherence measures were extracted and coded, and 23 unique measures were identified as assessing practical barriers and included in the final analysis. Seven key themes were identified: formulation; instructions for use; issues with remembering; capability—knowledge and skills; financial; medication supply and social environment.

Conclusion

Existing adherence measures capture a variety of practical barriers which can be grouped into seven categories. These findings may be used to inform the development of a measure of practical adherence barriers.

Relationships Between Pharmaceutical Therapy-Related Quality of Life and Health Utility Scores in Thai Patients With Chronic Diseases

OBJECTIVES

The purpose of this study was to assess the relationships between pharmaceutical therapy-related quality of life (PTRQoL) and health utility (HU) scores since such data was not available.

METHODS

The dataset of 1156 outpatients with chronic diseases from 3 public university hospitals in Bangkok, Thailand, were applied. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to assess PTRQoL. HU measures included EQ-5D-5L and EuroQoL-Visual Analog Scale (EQ-VAS). Multiple linear regressions using a stepwise approach were applied to evaluate the relationships between the PROMPT-QoL and the HU scores.

RESULTS

The results found that the EQ-5D-5L was mostly correlated with the impacts of medicines and side-effects followed by the medicine effectiveness, psychologic impacts of medication use, and availability and accessibility domains of the PROMPT-QoL, respectively (actual R² about 18%). The EQ-VAS was mostly associated with the impacts of medicines and side-effects, followed by the medicine effectiveness and overall quality of life domains, respectively (actual R² about 14%).

CONCLUSIONS

The PROMPT-QoL had medium correlations with the EQ-5D-5L and EQ-VAS scores. Their relationships depended on HU approaches used. More research is needed to examine the relationships between the PROMPT-QoL or other PTRQoL instruments and other HU scores in other settings and populations.

Translation and psychometric validation of a Danish version of the medication-related quality of life scale

Background Generic and disease specific health-related quality of life scales have been found to be non-responsive to changes in medications in polypharmacy patients. The Taiwanese medication-related quality of life (MRQoL) scale aims to measure the effect of medication use on patients' quality of life. Objective To evaluate the psychometric properties of the Danish translation of MRQoL in a population of patients with polypharmacy. Setting Polypharmacy patients waiting for services at a community pharmacy or hospital in Denmark. Method The original MRQoL included 14 items. It was forward-translated into Danish and backward-translated into Chinese according to a modified translation protocol proposed by Sousa and Rojjanasrirrat et al. The translation was pre-tested, adjusted, and administered to polypharmacy patients. The factor structure was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency reliability was evaluated, and criterion validity assessed using the beliefs about medicines questionnaire (BMQ) and SF-12v2. Known-group validity was carried out on age, number of medicines and setting. Main outcome measure Validity of the Danish version of the MRQoL-scale. Results 164 patients completed the questionnaire. EFA of all 14 items resulted in a two-factor structure, accounting for 72.8% of the total variance. The two factors were named "Energy/Concentration" (7 items) and "Feelings/Social" (7 items). Items correlating over 0.80 were removed leaving 11 items (Model 1). This model was further reduced to 8 items (Model 2) based on Cronbach's alpha. CFA confirmed the two-factor structure of both models. Model 2 fitted data without having to define covariations between error terms. Both factors showed high internal consistency reliability (Cronbachs' alpha 0.901-0.932). Ceiling effects were detected for both factors. Criterion validity was demonstrated via its significant correlations with SF-12vs2 subscales (Spearman's rho 0.340-0.353) and BMQ Concern (Spearman's rho - 0.451 to - 0.347). There was a statistically significant difference in relation to total scores of the MRQoL for age and number of drugs taken, indicating known-group validity. Conclusion The Danish translation of the MRQoL instrument showed measurement properties indicating a well-defined two-factor structure with high internal reliability, concurrent criterion validity, and known group validity. However, challenges remain with ceiling effects and efforts should be put into further development of the instrument.

Pharmacotherapy related quality of life in Thai patients with chronic diseases

Background Little was known about patient's pharmacotherapy related quality of life (PTRQoL) and its differences between disease groups. Objective First, to assess PTRQoL in Thai patients with chronic diseases using the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL). Second, to determine the differences in PROMPT-QoL domain scores and total scores between disease groups. Setting Three public university hospitals in Bangkok, Thailand. Method Eleven hundred and fifty-six adult outpatients continuously taking medicines to treat their diseases for at least 3 months were conveniently sampled. Bonferroni post hoc tests were used to determine the differences in eight PROMPT-QoL domain scores and total scores between 14 disease groups. Main outcome measure The descriptive statistics of PROMPT-QoL domains and the total score. Results Approximately two-thirds of all patients preferred to use only medicines for treating their diseases. Impacts of Medicines and Side-Effects and Medicine and Disease Information yielded the highest (87.3) and lowest (55.4) mean domain scores, respectively. The other domains and the total score provided the average scores between 65 and 75, which were interpreted as moderate-to-good. Bonferroni post hoc tests showed that there were five domains providing significantly different scores between disease groups. They included Medicine and Disease Information, Satisfaction with Medicine Effectiveness, Impacts of Medicines and Side-effects, Convenience, and Therapeutic Relationships with Healthcare Providers domains. Conclusion Pharmacotherapy related quality of life in Thai patients is moderate-to-good. Five of eight pharmacotherapy related quality of life domain scores differed by disease groups.

Development and psychometrics of a short-form pharmaceutical care-specific measure for quality of life

Background The validated patient-reported outcomes measure of pharmaceutical therapy for quality of life (PROMPT-QoL) contains 43-items, and can be too lengthy for some applications. Objectives To develop a brief version called the PROMPT, and test its psychometric properties. Setting Four public hospitals in Bangkok, Thailand. Method Secondary analysis of three databases used to develop and evaluate the original PROMPT-QoL. Items for the short-form PROMPT were selected based on expert and patient evaluations of content and importance, and lack of redundancy. All domains of the original version are represented in the PROMPT. Main outcome measures Psychometric properties (internal consistency and test-retest reliability, criterion, convergent and discriminant validity, and responsiveness), and indicators of practicality (e.g., administration time, missing data). Results Analyses of the PROMPT and its domain subscales demonstrated good internal consistency and fair-to-excellent test-retest reliability. Correlations between the original and short-form, overall and by domain, were high. Expectations for convergent and discriminant validity were met as correlations between the PROMPT and generic health-related quality of life measures (WHOQoL-BREF domains and summary scores of the SF-12v2) were modest (< 0.40). Based on data from a trial of pharmaceutical care, the PROMPT short-form was very responsive to reductions in medication related problems. Administration time for the PROMPT is estimated to be about 5 min, and across all datasets used, no missing data were found amongst the 16 items of the PROMPT. Conclusion The 16-item PROMPT appears to be a practical, reliable, valid, and responsive instrument to identify patient's drug-related needs and to assess the humanistic impact of patient-centered pharmaceutical care.

Pharmaceutical care and health related quality of life outcomes over the past 25 years: Have we measured dimensions that really matter?

Background Several measures of Health-Related Quality of Life (HRQoL) have been used to evaluate Pharmaceutical Care (PC) interventions in the past decades. However, their suitability for evaluation of PC services has not been comprehensively evaluated. Aim of the review The aim of this review was to perform content analysis of HRQoL measures used in PC studies to gain an insight into their suitability for evaluation of PC services. Method PC studies evaluating HRQoL as a primary or secondary outcomes were retrieved based on a literature search of articles published from 1990 to 2015, on Medline, Embase, International Pharmaceutical Abstracts, Global Health, PsycInfo, Web of Science, Cinahl, HealthStar, Cochrane Library, AUSThealth, Australian Medical Index, and Current content. Measures of HRQoL used in the studies were identified and relevant information was extracted. A conceptual model of a patient reported Medication-Related Burden Quality of Life was used to guide the analysis. Results 117 studies were retrieved. Thirty-seven: 10 generic, 27 condition-specific HRQoL measures with a total of 1019 items about physical functioning (n = 430), psychological wellbeing (n = 288), social wellbeing (n = 119), physical burden (n = 69) and others (n = 113) were used in the studies. Only 34 of 1019 items were specifically related to medicines. Of these, the majority of items focused on other aspects of medicine such as adherence, rather than the burden imposed by medicine on quality of life. Conclusion A holistic analysis of HRQoL measures used in PC studies published over two and half decades provided a better insight into sensitivity and specificity of the measures to PC services. This review found that HRQoL measures used in PC studies provide a very limited coverage of themes related to the burden of medicine on quality of life. Therefore, may have limited potential for use as a sole humanistic measure when evaluating PC interventions. There is a scope for future research in the development of an alternative measure suitable for evaluation of the burden of medicine and the impact of PC interventions on quality of life outcomes.

Development and validation of an instrument for measuring the burden of medicine on functioning and well-being: the Medication-Related Burden Quality of Life (MRB-QoL) tool

OBJECTIVE

Medication-related burden (MRB) is a negative experience with medicine, which may impact on psychological, social, physical and financial well-being of an individual. This study describes the development and initial validation of an instrument specifically designed to measure MRB on functioning and well-being-the Medication-Related Burden Quality of Life (MRB-QoL) tool.

METHODS

An initial pool of 76-items for MRB-QoL was generated. The link to MRB-QoL survey was sent to a sample of consumers living with at least one chronic medical condition and taking ≥3 prescription medicines on a regular basis. Exploratory factor analysis (EFA) was used to determine the underlining factor structure. Internal consistency (Cronbach's α) and construct validity were examined. The latter was examined through correlation with Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI) and Charlson's Comorbidity Index (CCI).

RESULTS

367 consumers completed the survey (51.2% male). EFA resulted in a 31-item, five-factor solution explaining 72% of the total variance. The five subscales were labelled as 'Routine and Regimen Complexity' (11 items), 'Psychological Burden' (six items), 'Functional and Role Limitation' (seven items), 'Therapeutic Relationship' (three items) and 'Social Burden' (four items). All subscales showed good internal consistency (Cronbach's α 0.87 to 0.95). Discriminant validity of MRB-QoL was demonstrated via its correlations with MRCI (Spearman's r -0.16 to 0.08), DBI (r 0.12 to 0.28) and CCI (r -0.23 to -0.15). Correlation between DBI and 'Functional and Role Limitation' subscale (r 0.36) indicated some evidence of convergent validity. Patients with polypharmacy, multiple morbidity and DBI >0 had higher median scores of MRB-QoL providing evidence for known group validity.

CONCLUSIONS

The MRB-QoL V.1 has good construct validity and internal consistency. The MRB-QoL may be a useful humanistic measure for evaluating the impact of pharmaceutical care interventions on patients' quality of life. Future research is warranted to further examine additional psychometric properties of MRB-QoL V.1 and its utility in patient care.

A randomized controlled trial of the impact of pharmacist-led patient-centered pharmaceutical care on patients' medicine therapy-related quality of life

BACKGROUND

Due to a lack of pharmaceutical care (PC)-specific measures for health-related quality of life, a novel generic questionnaire "Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was developed. Little was also known about an impact of pharmaceutical care on medicine therapy-related quality of life.

OBJECTIVE

First, evaluate the impact of PC on medicine therapy-related QoL using the PROMPT-QoL in Thai patients. Second, compare the outcomes of drug-related problems (DRPs) between usual care (UC) and PC groups. Third, assess the responsiveness of the PROMPT-QoL.

METHODS

A randomized controlled trial was conducted at a tertiary public hospital in Bangkok, Thailand from March to October 2016. A total of 514 patients were randomly allocated into the UC (N = 255) and pharmacist-led patient-centered PC (N = 259) groups. The follow-up period was three months.

RESULTS

A split-plot ANOVA showed that the PC group significantly improved four domain scores and total score of the PROMPT-QoL than the UC group (all p < 0.01). For improved patients in the PC group (N = 164), the responsiveness of these four domains and the total score was moderate-to-high with standardized effect sizes between 0.23 and 3.01. The PC group also significantly yielded higher proportion of patients with better DRP outcomes than the UC group (p < 0.01).

CONCLUSIONS

Pharmacist-led patient-centered PC could improve patients' medicine therapy-related QoL and DRP outcomes. Four out of eight domains and the total score of the PROMPT-QoL were responsive to assess a humanistic impact of PC. More research can be conducted in longer follow-up periods.

Psychometric Properties of the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QOL)

OBJECTIVES

To assess the psychometric properties of a novel instrument for medication management, the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QOL), using both conventional psychometrics and Rasch analysis in a large sample.

METHODS

This study was conducted with 1156 adult outpatients continuously taking any medicines at least 3 months from three university hospitals in Bangkok, Thailand, between July 2014 and March 2015. The psychometric properties were assessed in five steps: 1) assessment of dimensional structure, 2) item selection, 3) assessment of practicality, 4) assessment of reliability, and 5) assessment of criterion and known-groups validity.

RESULTS

The PROMPT-QOL contained 43 items including nine domains, and their five-point Likert scale functioning worked well. Most items fulfilled the item selection criteria. The PROMPT-QOL took an average administration time of 13.4 ± 5.8 minutes. Only two items had missing data of 0.1% to 0.2%. All domains provided good to excellent test-retest reliability with intraclass correlation coefficients between 0.67 and 0.83. All domains of the PROMPT-QOL yielded high Cronbach's α values between 0.77 and 0.89, greater than an acceptable level of 0.70, except for the Availability and Accessibility domain (0.58). A multiple regression showed that the Medication Effectiveness domain was the strongest predictor of the overall QOL of the PROMPT-QOL, followed by the Therapeutic Relationships, Psychological Impacts, Convenience, and Availability and Accessibility domains (adjusted R² ~ 52%). As expected, patients with higher PROMPT-QOL domain scores were associated with being younger, more educated, having a lower number of medicines, patients' perceptions of better disease control, having no adverse drug reactions, and medicine preference.

CONCLUSIONS

The PROMPT-QOL was practical, reliable, and valid for Thai patients.

Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire

BACKGROUND

Medicine-related burden is an increasingly recognized concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviors, including nonadherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire (LMQ) was developed for this purpose.

OBJECTIVE

This study validated the LMQ in a sample of adults using regular prescription medicines in the UK.

METHODS

Questionnaires were distributed in community pharmacies and public places in southeast England or online through UK health websites and social media. A total of 1,177 were returned: 507 (43.1%) from pharmacy distribution and 670 (56.9%) online. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and between those who did or did not require assistance with medicine use. Internal consistency was assessed by Cronbach's alpha. Free-text comments were analyzed thematically to substantiate underlying dimensions.

RESULTS

A 42-item, eight-factor structure comprising intercorrelated dimensions (patient-doctor relationships and communication about medicines, patient-pharmacist communication about medicines, interferences with daily life, practical difficulties, effectiveness, acceptance of medicine use, autonomy/control over medicines and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales had acceptable internal consistency (α>0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of the respondents, supported the domains identified.

CONCLUSION

The resultant LMQ-2 is a valid and reliable multidimensional measure of prescription medicine use experiences, which covers more diverse domains than existing questionnaires. However, further validation work is necessary.

Strategies for Expanding Access and Improving the Quality of Pharmaceutical Services

Pharmaceutical services are among the most accessible healthcare assistance systems worldwide, being provided generally in enterprises like Drugstores and Compounding Pharmacies. Pharmacists are highly accessible healthcare professionals considering also the availability, geographic distribution and location of pharmaceutical enterprises. However, there are several challenges for providing these services for patients with limitations such as low education, difficulties on reaching the Pharmacist, and the need for individualized monitoring (due to the complexity of therapy). Reports of low quality services are growing worldwide, and in order to expand access and improve the quality of pharmaceutical services, Pharmacists must move from being medication dispensers with focus in administrative management to a clinically-oriented practice with a humanistic view. The aim of this chapter is to make an approach on the implementation of effective strategies and ways to improve the quality of Pharmacists' work as specialized healthcare providers.

Measuring medicine-related experiences from the patient perspective: a systematic review

BACKGROUND

There is an increasing drive to measure and so improve patients' experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients' experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients' experiences of using prescription medicines and to examine their properties and suitability for use in research or practice.

METHODS

Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID®, and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes.

RESULTS

Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of patient involvement in both their development and validation.

CONCLUSION

There is a scarcity of psychometrically sound, comprehensive, and generic measures of experiences of using prescription medicines among adult patients living with chronic illnesses. There is a need for further development and/or validation of existing instruments suitable for use in this population.

Impact of Pharmaceutical Care Interventions on Health-Related Quality-of-Life Outcomes: A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the impact of pharmaceutical care (PC) interventions on health-related quality of life (HRQoL) and determine sensitivity of HRQoL measures to PC services.

DATA SOURCES

MEDLINE, EMBASE, International Pharmaceutical Abstracts, PubMed, Global Health, PsychINFO, CINAHL, and Web of Science (January 2005 to September 2015) were searched.

STUDY SELECTION AND DATA EXTRACTION

Original English-language articles were included if PC impact on HRQoL was evaluated and reported using validated HRQoL measures.

DATA SYNTHESIS

A total of 31 randomized controlled trials, 9 nonrandomized studies with comparison groups, and 8 before-after studies were included. PC interventions resulted in significant improvement in 1 domain and ≥3 domains of HRQoL measures in 66.7% and 27.1% of the studies, respectively. There was a significant improvement in at least 1 domain in 18 of 32 studies using generic and 16 of 21 studies using disease-specific measures. When the Short Form 36 Items Health Survey (SF-36) measure was used, PC interventions had a moderate impact on social functioning (standardized mean difference [SMD] = 0.59; 95% CI = 0.14, 1.04), general health (SMD = 0.36; 95% CI = 0.12, 0.59), and physical functioning (SMD = 0.30; 95% CI = 0.11, 0.48). The pooled data on heart failure-specific (SMD = -0.17; 95% CI = -0.43, 0.09), asthma-specific (SMD = 0.17; 95% CI = -0.03, 0.36), and chronic obstructive pulmonary disease-specific (SMD = -0.09; 95% CI = -0.37, 0.19) measures indicated no significant impact of PC on HRQoL.

CONCLUSIONS

PC interventions can significantly improve at least 1 domain of HRQoL. Existing measures may have minimal to moderate sensitivity to PC interventions, with evidence pointing more toward social functioning, general health, and physical functioning of the SF-36 measure. However, evidence generated from current non-PC-specific HRQoL measures is insufficient to judge the impact of PC interventions on HRQoL. The development of a suitable HRQoL measure for PC interventions may help generate better evidence for the contribution of pharmacist services to improving HRQoL.

Research philosophy in pharmacy practice: necessity and relevance

OBJECTIVE

Pharmacy practice has gradually evolved with the paradigm shifted towards patient-focused practice or medicines optimisation. The advancement of pharmacy-related research has contributed to this progression, but the philosophy of research remained unexplored. This review was thus aimed to outline the succinct concept of research philosophy and its application in pharmacy practice research.

KEY FINDINGS

Research philosophy has been introduced to offer an alternative way to think about problem-driven research that is normally conducted. To clarify the research philosophy, four research paradigms, i.e. positivism (or empiricism), postpositivism (or realism), interpretivism (or constructivism) and pragmatism, are investigated according to philosophical realms, i.e. ontology, epistemology, axiology and logic of inquiry. With the application of research philosophy, some examples of quantitative and qualitative research were elaborated along with the conventional research approach. Understanding research philosophy is crucial for pharmacy researchers and pharmacists, as it underpins the choice of methodology and data collection.

CONCLUSIONS

The review provides the overview of research philosophy and its application in pharmacy practice research. Further discussion on this vital issue is warranted to help generate quality evidence for pharmacy practice.