Beyene Kebede, Chan Amy Hai Yan, Bandreddi Naga Sai Trisha, Tabar Reihaneh Bassam, Moyle Emily, Nath Sokunvattey, Wang Nianwen, Harrison Jeff
The School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
Int J Clin Pharm. 2021 Feb;43(1):154-164. doi: 10.1007/s11096-020-01124-y. Epub 2020 Aug 18.
Background Community pharmacist-led anticoagulation management service (CPAMS) offers international normalised ratio point-of-care testing of warfarin in a community pharmacy setting. It has now expanded with 7,344 patients enrolled in the service across 164 pharmacies in New Zealand. The clinical benefit of CPAMS has been shown to be superior, but patient satisfaction with the service has not been fully explored. Objective To develop a questionnaire to assess patient satisfaction with CPAMS and evaluate its psychometric properties. Additionally, to determine the level of patient satisfaction with CPAMS and identify determinants of satisfaction with CPAMS. Settings 1071 patients enrolled in CPAMS across New Zealand invited to take part in the study. Main outcome measure Satisfaction with CPAMS service. Methods Adult patients taking warfarin and currently enrolled in CPAMS were recruited through the national international normalised ratio online system and invited to complete a 36-item survey assessing satisfaction with CPAMS. To identify the most important dimensions of patient satisfaction, exploratory factor analysis was used. Multivariate linear regression models were used to examine the effect of independent variables on patient satisfaction. Results A total of 305 patients completed the survey. The mean overall satisfaction score was 94.5% ± 13.1 out of maximum possible points. Five dimensions of patient satisfaction were identified by factor analysis: patient-centred communication, confidence in pharmacist competence, patient-pharmacist relationship, confidence in CPAMS, and pharmacy environment. Being older and more frequent visits to a pharmacy were positively associated with patient satisfaction. Living more than 1 km away from a pharmacy, and 'poor' self-perceived health status were negative predictors of patient satisfaction. Being Māori or of other ethnic minority was also associated with lower satisfaction scores, exploratory analysis suggests patient-pharmacist relationship is an important driver of these differences. Conclusions The high level of patient satisfaction further supports the effectiveness of CPAMS as a delivery model. Patient satisfaction is affected by age, frequency of pharmacy visits, ethnicity, travel distance to pharmacy, and perceived health status. Policy makers and practitioners should consider the characteristics of patients with low levels of satisfaction to improve and enhance CPAMS engagement.
背景 由社区药剂师主导的抗凝管理服务（CPAMS）可在社区药房环境中提供华法林的国际标准化比值即时检测。该服务现已扩展，新西兰164家药房中有7344名患者登记使用。CPAMS的临床益处已被证明更具优势，但患者对该服务的满意度尚未得到充分探究。目的 编制一份问卷以评估患者对CPAMS的满意度并评估其心理测量特性。此外，确定患者对CPAMS的满意度水平并找出影响CPAMS满意度的因素。环境 邀请新西兰1071名登记使用CPAMS的患者参与研究。主要结局指标 对CPAMS服务的满意度。方法 通过国家国际标准化比值在线系统招募正在服用华法林且目前登记使用CPAMS的成年患者，并邀请他们完成一项36项的调查，以评估对CPAMS的满意度。为确定患者满意度的最重要维度，采用探索性因素分析。使用多元线性回归模型来检验自变量对患者满意度的影响。结果 共有305名患者完成了调查。总体满意度平均得分为94.5%±13.1（满分）。通过因素分析确定了患者满意度的五个维度：以患者为中心的沟通、对药剂师能力的信心、患者与药剂师的关系、对CPAMS的信心以及药房环境。年龄较大和更频繁地光顾药房与患者满意度呈正相关。居住在距离药房1公里以上的地方以及自我感觉“健康状况不佳”是患者满意度的负向预测因素。毛利人或其他少数民族也与较低的满意度得分相关，探索性分析表明患者与药剂师的关系是这些差异的重要驱动因素。结论 患者的高度满意度进一步支持了CPAMS作为一种服务模式的有效性。患者满意度受年龄、光顾药房的频率、种族、到药房的行程距离以及自我感知的健康状况影响。政策制定者和从业者应考虑满意度较低患者的特征，以改进和加强对CPAMS的参与度。
