Kansanaho Heli M, Puumalainen Inka I, Varunki Maaret M, Airaksinen Marja Sa, Aslani Parisa
Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, Helsinki, Finland.
Ann Pharmacother. 2004 Nov;38(11):1946-53. doi: 10.1345/aph.1E050. Epub 2004 Oct 5.
Concordance is a new model of interaction between healthcare professionals and patients. The work of pharmacists and patients in the consultation is a negotiation between equals, and the aim is therapeutic alliance between them.
To assess Finnish community pharmacists' attitudes toward concordance and its perceived impact on pharmacist-patient consultations during a 4-year Finnish project (TIPPA Project 2000-2003) aimed at promoting patient counseling.
A survey of a random sample of 734 community pharmacists in Finland was conducted in 2002. The questionnaire included an attitudinal scale and 2 open-ended questions on the impact of the TIPPA Project on patient counseling. Attitudes toward concordance were measured using a modified version of the LATCon scale. The construct validity and internal consistency of the scale were evaluated using factor analysis and Cronbach's alpha. Mean summative factor scores (MSS) and 95% confidence intervals were calculated for each factor. The responses to the open-ended questions were content analyzed.
A response rate of 51% (n = 376) was obtained. Almost 80% of the respondents strongly agreed that the highest priority in patient counseling was to establish a therapeutic alliance between the pharmacist and patient. Factor analysis of the attitudinal scale yielded 3 primary factors explaining 37.6% of the variance, interpreted as respecting patients' beliefs (alpha = 0.60; MSS = 1.90; 95% CI 2.25 to 2.40), establishing a therapeutic alliance (alpha = 0.65; MSS = 1.36; 95% CI 1.31 to 1.40), and sensitivity to patients' reactions (alpha = 0.66; MSS = 2.33; 95% CI 1.83 to 1.96). Results of the open-ended questions indicated that the TIPPA Project had a positive impact on pharmacists' attitudes toward concordance.
Respondents to our survey were supportive of concordance. The TIPPA Project elicited a positive impact on pharmacists' attitudes toward counseling. Pharmacist education through programs such as TIPPA can aid in the implementation of a concordance-based counseling practice.
一致性是医疗保健专业人员与患者之间互动的一种新模式。药剂师与患者在咨询过程中的工作是平等之间的协商，目的是在他们之间建立治疗联盟。
在一项为期4年的旨在促进患者咨询的芬兰项目（TIPPA项目，2000 - 2003年）中，评估芬兰社区药剂师对一致性的态度及其对药剂师 - 患者咨询的感知影响。
2002年对芬兰734名社区药剂师的随机样本进行了一项调查。问卷包括一个态度量表和2个关于TIPPA项目对患者咨询影响的开放式问题。使用LATCon量表的修改版来测量对一致性的态度。使用因子分析和克朗巴哈系数评估量表的结构效度和内部一致性。计算每个因子的平均汇总因子得分（MSS）和95%置信区间。对开放式问题的回答进行了内容分析。
获得了51%（n = 376）的回复率。近80%的受访者强烈同意，患者咨询的最高优先事项是在药剂师和患者之间建立治疗联盟。态度量表的因子分析产生了3个主要因子，解释了37.6%的方差，解释为尊重患者的信念（α = 0.60；MSS = 1.90；95% CI 2.25至2.40）、建立治疗联盟（α = 0.65；MSS = 1.36；95% CI 1.31至1.40）以及对患者反应的敏感性（α = 0.66；MSS = 2.33；95% CI 1.83至1.96）。开放式问题的结果表明，TIPPA项目对药剂师对一致性的态度产生了积极影响。
我们调查的受访者支持一致性。TIPPA项目对药剂师对咨询的态度产生了积极影响。通过TIPPA等项目进行药剂师教育有助于实施基于一致性的咨询实践。
