Jakobsen Ann Helen, Sato Noriko, Chen Timothy F, Fujita Kenji, Småbrekke Lars, Halvorsen Kjell H
Clinical Pharmacy and Pharmacoepidemiology (IPSUM research group), Department of Pharmacy, The Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsoe, Norway.
Pharmacy Practice Research, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Int J Pharm Pract. 2025 Jul 24;33(4):386-392. doi: 10.1093/ijpp/riaf030.
Community pharmacies in Norway offer accessible healthcare services that require monitoring. Relevant and realistic quality indicators (QIs) must be developed to establish standards. This study aimed to establish consensus on healthcare quality measures in a community pharmacy setting by implementing two distinct approaches.
A comprehensive multi-phase research design was implemented to identify, define, and select potential QIs for community pharmacies. Potential QIs were identified and nominated from workshops, focus groups, and literature. Thirteen panellists were recruited for a modified Delphi study over two rounds. We used the RAND/UCLA Appropriateness Method (RAM) panel median ratings and disagreement index (DI) to assess appropriateness and disagreement and define consensus.
We identified 192 QIs from workshops, focus groups and literature searches. After duplicates were removed and QIs with similar wording were merged, 137 QIs were nominated for the first Delphi round. The panellists deemed 61 appropriate, two inappropriate and excluded six QIs in the first round. The remaining 68 QIs were assessed in Round 2, where 23 achieved consensus as appropriate without disagreement. After DI was calculated, the number of QIs categorized as appropriate without disagreement after Round 1 and 2 was 34 and 10, respectively.
This study demonstrates the use of the RAM combined with the DI to establish consensus on healthcare quality measures, i.e. QIs for community pharmacy services. Our findings indicate that the number of QIs considered acceptable is strongly impacted by the method chosen to handle disagreement in the ratings. Incorporating DI and conventional RAM disagreement calculations reduced the number of QIs deemed acceptable by half.
挪威的社区药房提供需要监测的可及医疗服务。必须制定相关且现实的质量指标（QIs）以确立标准。本研究旨在通过实施两种不同方法就社区药房环境中的医疗质量措施达成共识。
实施了一项全面的多阶段研究设计，以识别、定义和选择社区药房的潜在质量指标。通过研讨会、焦点小组和文献确定并提名潜在质量指标。招募了13名专家组成员进行两轮改进的德尔菲研究。我们使用兰德/加州大学洛杉矶分校适宜性方法（RAM）小组中位数评分和分歧指数（DI）来评估适宜性和分歧并确定共识。
我们从研讨会、焦点小组和文献检索中识别出192个质量指标。去除重复项并合并措辞相似的质量指标后，137个质量指标被提名为第一轮德尔菲研究。专家组成员在第一轮中认为61个适宜，2个不适宜并排除了6个质量指标。其余68个质量指标在第二轮中进行评估，其中23个达成适宜且无分歧的共识。计算分歧指数后，第一轮和第二轮后被归类为适宜且无分歧的质量指标数量分别为34个和10个。
本研究展示了使用RAM结合DI就医疗质量措施（即社区药房服务的质量指标）达成共识。我们的研究结果表明，被认为可接受的质量指标数量受到处理评分分歧所选用方法的强烈影响。纳入DI和传统的RAM分歧计算使被认为可接受的质量指标数量减少了一半。
