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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
PubMed
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.

Keywords:
clinical practicecommunity pharmacypatient safetypharmaceutical public healthprofessional practiceresearch methods

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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.