Pinto Sharrel L, Lively Buford T, Siganga Walter, Holiday-Goodman Monica, Kamm Gayle
Pharmacy Health Care Administration, University of Toledo College of Pharmacy, Toledo, OH 43606, USA.
Res Social Adm Pharm. 2006 Mar;2(1):38-58. doi: 10.1016/j.sapharm.2005.11.001.
Diabetes is one of the deadliest and most costly diseases. Attrition rates among patients in diabetes management programs may preclude optimal success. Theoretical models, such as the Health Belief Model, may be useful for identifying factors responsible for patients' continued enrollment in such programs.
(1) To design and test a reliable and valid survey instrument for assessing patients' perceptions of diabetes-related pharmaceutical care services. (2) To determine factors affecting patient retention in pharmaceutical care services.
This cross-sectional exploratory study used convenience sampling to survey type 1 and 2 diabetes patients receiving pharmaceutical care at 25 Eckerd Pharmacy sites in Florida. Survey items were designed using constructs from the Health Belief Model. Reliability (Cronbach's alpha) and validity (exploratory factor analysis) were assessed. Independent t tests, Pearson's correlation coefficients, and multiple regression analysis were conducted.
Seventy usable surveys were returned (47%). In the absence of pharmaceutical care, patients felt susceptible to at least one of 8 diabetes-related conditions (hypoglycemia, hyperglycemia, diabetic foot infections, eye problems, cardiovascular risks, blood pressure problems, cholesterol problems, and kidney diseases). For these conditions, about 48% to 95% of patients perceived that their threat had reduced because of pharmaceutical care. Accordingly, more than half perceived the services as beneficial, with counseling for blood sugar monitoring rated as the most beneficial. All respondents rated the services as helpful, and 64 intended to continue regular utilization. Overall helpfulness of the service and patient retention were positively correlated (r=0.33, P<.00). Perceived susceptibility predicted perceived threat reduction (R(2)=0.22, P<.01). Perceived threat reduction, blood sugar monitoring, and overall helpfulness of the service predicted patient retention in the service (R(2)=0.41, P<.00). Factor analysis extracted 4 factors: perceived threat reduction, perceived susceptibility, perceived benefits, and blood sugar monitoring. Cronbach's alphas for the scales ranged from 0.63 to 0.91.
Two key constructs of the Health Belief Model influence use of diabetes-related pharmaceutical care services: perceived susceptibility and threat reduction. In an effort to increase patient retention, pharmacists need to assess patient perceptions and structure their services to address patient perceptions and concerns.
糖尿病是最致命且成本最高的疾病之一。糖尿病管理项目中的患者流失率可能会妨碍取得最佳成效。诸如健康信念模型等理论模型，可能有助于识别促使患者持续参与此类项目的因素。
（1）设计并测试一种可靠且有效的调查问卷，用于评估患者对糖尿病相关药学服务的认知。（2）确定影响患者在药学服务中留存率的因素。
这项横断面探索性研究采用便利抽样法，对佛罗里达州25家Eckerd药房接受药学服务的1型和2型糖尿病患者进行调查。调查问卷项目依据健康信念模型的构建要素设计。评估了信度（克朗巴哈系数）和效度（探索性因子分析）。进行了独立t检验、皮尔逊相关系数分析和多元回归分析。
共收回70份有效调查问卷（回收率47%）。在未接受药学服务时，患者感觉自己易患8种糖尿病相关病症中的至少一种（低血糖、高血糖、糖尿病足感染、眼部问题、心血管风险、血压问题、胆固醇问题和肾脏疾病）。对于这些病症，约48%至95%的患者认为药学服务降低了他们面临的威胁。相应地，超过半数的患者认为这些服务有益，其中血糖监测咨询被评为最有益的。所有受访者都认为这些服务有帮助，64人打算继续定期使用。服务的总体帮助程度与患者留存率呈正相关（r = 0.33，P <.00）。感知易感性可预测感知威胁降低（R² = 0.22，P <.01）。感知威胁降低、血糖监测以及服务的总体帮助程度可预测患者在服务中的留存率（R² = 0.41，P <.00）。因子分析提取出4个因子：感知威胁降低、感知易感性、感知益处和血糖监测。各量表的克朗巴哈系数在0.63至0.91之间。
健康信念模型的两个关键构建要素影响糖尿病相关药学服务的使用：感知易感性和威胁降低。为提高患者留存率，药剂师需要评估患者的认知，并构建服务以解决患者的认知和担忧。
