Planas Lourdes G, Kimberlin Carole L, Segal Richard, Brushwood David B, Hepler Charles D, Schlenker Barry R
Department of Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma, P.O. Box 26901, Oklahoma City, OK 73190, USA.
Soc Sci Med. 2005 May;60(10):2393-403. doi: 10.1016/j.socscimed.2004.10.018. Epub 2004 Dec 9.
Pharmacists in community and ambulatory care settings are in a unique position to reduce drug-related morbidity and to optimize patient outcomes by identifying, resolving, and preventing drug therapy problems. This particular approach to pharmacy practice expands traditional pharmacist responsibilities of dispensing pharmaceuticals and providing drug information to optimizing patients' drug therapy outcomes. However, pharmacists in general, and community pharmacists in particular, have yet to incorporate this expanded professional role into daily practice. The objective of this study was to examine the validity of a pharmacist model of perceived responsibility for drug therapy outcomes based on the triangle model of responsibility. A survey instrument was tested among community and ambulatory care pharmacists in Florida, USA. The survey instrument contained the following pharmacist-related constructs from the model: clarity of standards, personal control, professional duty, and perceived responsibility for drug therapy outcomes. The model was examined by testing hypothesized relationships between the model constructs and pharmacists' reports of providing pharmaceutical care. The survey response rate was 40.9% (525/1283). All of the study measures exhibited Cronbach alpha values greater than .70. A measurement model was tested using confirmatory factor analysis. The chi2/df ratio (3.02), CFI (.95), and residual (.051) indicated a good fit of the item data to the constructs. According to path analysis, clarity of standards, personal control, and professional duty were significantly related to perceived responsibility for drug therapy outcomes, which in turn, was significantly related to pharmaceutical care provision. Perceived responsibility for drug therapy outcomes acted as a mediator of the effects of clarity of standards, personal control, and professional duty on pharmaceutical care provision. These findings have implications for pharmacy practice and research.
社区和门诊护理环境中的药剂师处于独特地位，能够通过识别、解决和预防药物治疗问题来降低与药物相关的发病率，并优化患者治疗效果。这种特殊的药学实践方法将药剂师传统的药品调配和提供药物信息的职责扩展到优化患者的药物治疗效果。然而，一般的药剂师，尤其是社区药剂师，尚未将这一扩展后的专业角色纳入日常实践。本研究的目的是基于责任三角模型检验药剂师对药物治疗效果的感知责任模型的有效性。在美国佛罗里达州的社区和门诊护理药剂师中对一份调查问卷进行了测试。调查问卷包含该模型中以下与药剂师相关的构念：标准清晰度、个人控制、职业职责以及对药物治疗效果的感知责任。通过测试模型构念与药剂师提供药学服务报告之间的假设关系来检验该模型。调查回复率为40.9%（525/1283）。所有研究指标的克朗巴哈系数值均大于0.70。使用验证性因子分析测试了一个测量模型。卡方/自由度比（3.02）、比较拟合指数（.95）和残差（.051）表明项目数据与构念拟合良好。根据路径分析，标准清晰度、个人控制和职业职责与对药物治疗效果的感知责任显著相关，而后者又与药学服务的提供显著相关。对药物治疗效果的感知责任在标准清晰度、个人控制和职业职责对药学服务提供的影响中起中介作用。这些发现对药学实践和研究具有启示意义。
