The structural and process aspects of pharmacy quality: older adults’ perceptions
- 469 Downloads
Background Patients are increasingly playing an active role in healthcare and their definitions of healthcare quality are becoming more important to understand. The Donabedian model has been used to understand patients’ perceptions of quality in healthcare settings including hospitals and nursing homes; no research has applied the model to understand patients’ perceptions of pharmacy quality. Objective To describe older adults’ perception of a quality pharmacy including their expectations of a quality pharmacy and their preferences in a quality pharmacy. Setting Six focus groups held in community centers and senior residence facilities in Wisconsin. Methods The design was a descriptive, exploratory study. Participants were adults 65 years and older who filled a prescription at a community pharmacy in the 90 days prior to being contacted. Donabedian’s assessment of healthcare quality based on ‘structure,’ ‘process’ and ‘outcome’ was used to organize and categorize the focus group themes. Main outcome measure The focus groups explored older adults’ perceptions and expectations of a quality pharmacy. The factors that influenced their pharmacy choice were also examined. Results The older adults’ description of a quality pharmacy was based on the ‘structure’ and ‘process’ domain of the Donabedian model. However, most responses were focused on the ‘process’ domains and related to the application of patient-centered care (e.g., pharmacist interaction and communication) versus the structure domains (e.g., staff availability). The most frequently reported factor in the choice of pharmacies was the pharmacy’s location with some participants also reporting that their relationship and rapport with the pharmacist were also important. Older adults’ expectations were focused on the ‘process’ features of quality, including the provision of medication-related information, and the pharmacist facilitating medication safety and medication adherence. Conclusions In describing pharmacy quality, older adults mostly refer to the ‘process’ aspects of quality. Older adults perceive a quality pharmacy as one where the pharmacist provides patient-centered care. While location is important in pharmacy choices, the pharmacist’s patient-centeredness, and the quality features of the pharmacy are also relevant. Older adults’ expectations were related to their perception of a quality pharmacy. Pharmacists should publicize their pharmacies’ ‘process’ features in quality reporting systems.
KeywordsCommunity pharmacy Donabedian model Older adults Quality United States
The authors would like to acknowledge the Community Academic Aging Research Network (CAARN) for helping with the recruitment of older adults into the study. The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the National Institute of Health (NIH) National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
No specific funding was received to complete this study.
Conflicts of interest
There are no conflicts of interest.
- 1.Institute of Medicine. Crossing the Quality Chasm: a New Health System for the 21st Century. Vol. 6. Washington: National Academy Press; 2001. ISBN-13: 978-0309072809.Google Scholar
- 18.Piligrimiene Z, Buciuniene I. Different perspectives on health care quality: is the consensus possible? Inzinerine Ekon Eng Econ. 2008;1:104–10.Google Scholar
- 19.Fact Sheet: Medicine use and older adults. [Internet] [cited 1 Feb 2015] http://www.mustforseniors.org/documents/must_factsheet.pdf.
- 20.Jepson M, Jesson J, Kendall H, Pocock R. Consumer expectations of community pharmaceutical services: a research report for the department of health. Aston University Pharmacy Practice Group Social and Consumer Research Unit, MEL Research, Aston Science Park, Birmingham, UK; 1991.Google Scholar
- 21.Miles M, Huberman M, Saldaña J. Qualitative data analysis: a methods sourcebook. Los Angeles: Sage Publications; 2014. ISBN-13: 978-1452257877.Google Scholar
- 22.Saldaña J. The coding manual for qualitative researchers. London: Sage Publications; 2009. ISBN-13: 978-1446247372.Google Scholar
- 23.McMillan SS, Kelly F, Sav A, King MA, Whitty JA, Wheeler AJ. Australian community pharmacy services: a survey of what people with chronic conditions and their carers use versus what they consider important. BMJ Open. 2014; 4(12). doi: 10.1136/bmjopen-2014-006587.
- 27.Morrow N, Hargie O, Woodman C. Consumer perceptions of and attitudes to the advice-giving role of community pharmacists. Pharm J. 1993;251:25–7.Google Scholar
- 28.Passmore PR, Kailis SG. Pharmacy practice consumer perspectives. Aust Pharm. 1990;9:178–84.Google Scholar
- 29.Krass I. A comparison of clients’ experiences of counselling for prescription and over-the-counter medication in two types of pharmacies: validation of a research instrument. J Soc Adm Pharm. 1996;13:206–14.Google Scholar
- 35.Pharmacy Quality Alliance. PQA endorsed set of measures. [cited 2015 August 5] http://pqaalliance.org/measures/default.asp.pdf.
- 36.Warholak TL, Nau D. Quality and safety in pharmacy practice. New York, NY: Mcgraw-Hill Medical; 2010. ISBN-13: 978-0071603850.Google Scholar