Development of Instruments to Measure the Quality of Patient Counselling

Even though patient counselling is considered one of the main duties for community pharmacists, studies have indicated that there is room for improvement in counselling performance. In order to enhance patient counselling practise in Finland, a four-year project TIPPA was launched in 2000. A need for patient counselling specific instruments became evident in order to implement new behaviours and to evaluate existing counselling practices. The aim of this study was to develop instruments to measure the quality of patient counselling. The process was started with a validation of the United States Pharmacopeia (USP) Medication Counselling Behaviour Guidelines. The construct validity and internal consistency of the Guidelines were evaluated by conducting factor analysis and assessing Cronbach's alpha. The statistical analysis indicated that the Guidelines are a valid and reliable instrument. The next step was to assess their usefulness among Finnish pharmacy practitioners 2,5 years after the TIPPA had started by sending a questionnaire to a random sample of community pharmacists (response rate 51%, n=376). More than one quarter (27%) of the respondents were aware of the Guidelines. The Guidelines were made known to the respondents mostly via a book on patient counselling skills (41% of those knowing the Guidelines), continuing education (37%), and in-house training (28 %). Over 60% of those who knew about the Guidelines regarded them as a good or very good instrument for learning the principles of patient counselling. The applicability of the Guidelines as an instrument for self-evaluation of performance in different settings was considered less useful. Factors related to the quality of patient counselling were determined as part of the training of ten external auditors of counselling practices. A modified Delphi method was used, with two expert panels: Panel 1, consisting of experienced pharmacy practitioners (n=10), and Panel 2, consisting of academic and professional experts (n=10). The final consensus was assessed by a Delphi questionnaire round (response rate 74%, n =26). The first Delphi round yielded a high consensus, the level of agreement varying between 69% and 100%. All the items except one met the predefined criteria for approval. A total of 16 indicators were identified in three quality dimensions: Customer (4 indicators); Process (6 indicators); and Learning and Innovations (6 indicators). Strategy and vision of the pharmacy in patient counseling formed the core of the instrument. A pseudo customer method that takes into account the professional content of counselling was developed to assess patient counselling practices in community pharmacies during the project. Counselling practices were annually evaluated in sixty selected community pharmacies by using four different scenarios (three self-medications and one prescription). The scoring criteria were based on the USP Guidelines and were divided into two categories: Needs Assessment and Instructions for Use. Two out of the four scenarios used showed a statistically significant increase between the baseline and the final follow-up. The results of the national pseudo customer studies indicate that more emphasis should be paid to customers asking for a self-medication product by a brand name and to customers with repeat prescriptions. The instruments developed in this study can be used in the evaluation of counselling practices at different levels. At the organisational level, the patient counselling quality assurance instrument can be used in conducting a present state analysis of counselling practices and constructing a long-term development plan. The quality assurance instrument can also be used in an external auditing process of counselling practices. The pseudo customer method can be applied at the organisational and national level to assess counselling performances. Individual pharmacists can use the USP Guidelines in self-evaluation and peer-evaluation of counselling practice. In order to implement good quality patient counselling practices, current practices need to be evaluated in a wider perspective than the customer-pharmacist interaction. National Library of Medicine Classification: W 85, QV 737 Medical Subject Headings: community pharmacy services; pharmacies; pharmacists; patient education; directive counselling; quality of health care; self-care