Validation of self-assessment of community pharmacy services

Abstract

Quality improvement measures support community pharmacist professional practice and may serve to improve service provision. The aim of the research was to develop, validate, and evaluate a self-assessment tool for clinical community pharmacy services. The methodology involved: 1) identification of quality standards for clinical community pharmacy services, 2) development of a self-assessment tool for community pharmacists, 3) content validation using a two-round Delphi study with a nine-member expert panel, where a mean score ≥4.5 was used as a threshold for acceptance, 4) reliability testing using the test-retest method performed by ten pharmacists, 5) criterion validation using the 2016 self-assessment tool of the National Competency Standards of the Pharmaceutical Society of Australia used as the gold standard, and 6) implementation of the tool in 30 community pharmacies. Quality standards for professional pharmacy services were identified from Australia, Malta, the United Kingdom and the United States of America. The self-assessment tool developed consists of 7 domains namely: 1) professional practice, 2) patient care and medicine management, 3) dispensing practices and counselling, 4) collaboration with health care professionals and colleagues, 5) pharmacist training and professional development, 6) management of stock and pharmacy environment, 7) quality assurance and quality management. The self-assessment tool relies on performance rating using a Likert scale from 1 (Poor) to 5 (Excellent). Each domain consists of a self-reflection section, where the pharmacist reflects to highlight strengths, weaknesses, and plan for improvement. Following round I of the Delphi study, statements were amended according to the recommendations and all statements obtained a mean rating score greater than 4.5 after round II. Reliability testing resulted in a Cronbach’s Alpha value of 0.991, indicating high internal consistency. For criterion validation, the paired sample t-test was applied. Criterion validation was established for Domains 5, 6 and 7 (p >0.05). Domains 1, 2, 3 and 4 showed a significant difference between the developed tool and the gold standard (p<0.05). From the implementation study, 9 participants rated the practicality of the tool as ‘Excellent,’ while 2 rated it as ‘Poor’, 10 participants rated the applicability of the tool as ‘Excellent’, while 1 rated it as ‘Poor’. Most participants are likely to perform quality indicators (n=20), participate in training (n=25) and plan for training of pharmacy personnel (n=21) to improve the quality of their pharmaceutical service. The psychometrically evaluated self-assessment tool may be used as a quality indicator for community pharmacies. The tool allows for accountability, continuous improvement and consistency in the provision of quality care. Further studies may look into the impact of the tool towards improved trust in the community pharmacist.