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Development of quality indicators for a community pharmacy setting
Ann Helen Jakobsen1, Noriko Sato2, Timothy F Chen2
1Clinical Pharmacy and Pharmacoepidemiology (IPSUM research group), Department of Pharmacy, The Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsoe, Norway.
The International Journal of Pharmacy Practice
|May 25, 2025
Summary
Developing healthcare quality indicators (QIs) for Norwegian community pharmacies is crucial. This study used the RAND/UCLA Appropriateness Method (RAM) and disagreement index (DI) to reach consensus on QIs, finding that disagreement handling significantly impacts acceptable measures.
Area of Science:
- Pharmaceutical Health Services Research
- Quality Improvement in Healthcare
- Pharmacy Practice and Management
Background:
- Community pharmacies in Norway provide accessible healthcare services requiring standardized quality monitoring.
- Establishing relevant and realistic quality indicators (QIs) is essential for setting community pharmacy standards.
- Previous methods for QI development may not adequately address consensus-building in diverse settings.
Purpose of the Study:
- To establish consensus on healthcare quality measures (QIs) for community pharmacy services in Norway.
- To implement and evaluate two distinct approaches for developing and selecting QIs.
- To assess the impact of disagreement handling on the final selection of QIs.
Main Methods:
- A multi-phase research design was employed, including workshops, focus groups, and literature reviews to identify potential QIs.
- A modified Delphi study involving thirteen panellists over two rounds was conducted.
- The RAND/UCLA Appropriateness Method (RAM) with panel median ratings and disagreement index (DI) was used to assess QI appropriateness and achieve consensus.
Main Results:
- Initially, 192 potential QIs were identified, reduced to 137 after merging and removing duplicates.
- In Round 1, 61 QIs were deemed appropriate. In Round 2, 23 QIs achieved consensus without disagreement.
- The total number of QIs considered appropriate without disagreement after both rounds was 34 (using RAM) and 10 (incorporating DI).
Conclusions:
- The RAND/UCLA Appropriateness Method (RAM) combined with the disagreement index (DI) effectively establishes consensus on QIs for community pharmacy services.
- The method chosen for handling disagreement in panel ratings significantly influences the number of QIs considered acceptable.
- Incorporating DI and conventional RAM disagreement calculations reduced the number of acceptable QIs by half, highlighting the importance of rigorous consensus methods.
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