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Title: Defining and assessing quality in community pharmacy
Author: Halsall, Devina
ISNI:       0000 0004 2689 943X
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2010
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Background and Aims: One method for understanding the quality of care provided by community pharmacies is to assess it using objective measures such as indicators. These, however, should be based on a common frame of reference for describing quality. As no such definition exists specifically for community pharmacy, this research aimed to gain an understanding of community pharmacy quality and its assessment. Methodology: In order to conceptualise community pharmacy quality, ten focus groups were conducted across the northwest of England with 47 purposively sampled participants who had experiences with community pharmacy healthcare services. Constant comparative analysis was used to analyse the verbatim transcripts. To develop the quality indicators, a scoping review was conducted to identify descriptive statements which mirrored the quality attributes and quality dimensions analysed from the focus groups. Then, once customised into clearly defined statements with a measurable element, 458 potential quality indicators were arranged into four questionnaires to be rated on their face-validity. Finally, consensus was gathered on each indicator's face-validity by using a two-round modified Delphi technique. Panellists were recruited from across England and were community pharmacists or PCT employees who were involved with community pharmacies (second round: n₁=20, n₂=19, n₃=19, n₄=19). Findings: It emerged that community pharmacy quality can be conceptualised as dynamic and complex with interdependent dimensions of 'opportunity', 'effectiveness' and 'positive perceptions of the experience'. Each dimension contains structures, processes and associated outcomes. These were illustrated by a dynamic model of quality dimensions and by its related static framework of structures processes and outcomes. In the Delphi questionnaires, a total of 51 potential indicators were added by panellists, and after the second rounds, 452 indicators achieved consensus for having face-validity as community pharmacy quality indicators. These assessed one or more of the three quality dimensions and related to: the pharmacy environment, equipment and facilities; patient access to medicines, advice and services; effectiveness; and management and leadership in the pharmacy. Ten indicators achieved consensus for lacking face-validity, and 47 indicators did not achieve consensus. Discussion: This research provides a foundation for future work in community pharmacy quality, and could enable those who design, develop and provide pharmacy services to better target their efforts in delivering high quality care. The quality indicators may help with assessing pharmacies and with making changes based on objective data. Before the 452 quality indicators are implemented, future study should include testing them in pharmacies to determine their reliability, feasibility and acceptability. Other recommendations for research, policy and practice are outlined in the text.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available