Development and validation of a new instrument to measure the socioeconomic impact of medication-related problems in community pharmacy setting

摘要

The social and economic impact of medication-related problems (MRPs) of cardiovascular drugs has been under-reported in the community setting. Cardiovascular patients on multiple drug therapy do not know whether side-effects they experience are medication-related or due to their condition. The aim of this study was therefore to develop a system to detect medication side-effects of cardiovascular drugs and their impact on patients' social and economic well-being. The problem was overcome by developing a Socioeconomic Impact Profile (SEIP) questionnaire in which patients were asked if they experienced medication side-effects and what impact these MRPs have on their ability to work, socialise or use healthcare services. The Socioeconomic Impact Profile (SEIP) consisted of 19 items in three domains. Each item was scored from 1 to 5 (1=all of the time, 2=most of the time, 3=some of the time, 4=a little of the time, 5=never). Higher scores indicated better socioeconomic well-being. Psychometric evaluation of the SEIP was carried out in 348 patients with cardiovascular disease (mean age=58.8, median=58.5, age range=37-84, male 175, female=173) recruited from five pharmacies across South West England and South Wales. The SEIP was generally acceptable to most patients with a mean completion time of 5.7 minutes. A high level of agreement among expert panel members on all items of the SEIP was achieved during content validation (Kappa coefficient "k"= 0.85). Factor analysis was used to identify redundant items and also provide initial evidence of construct validity. Evidence supporting internal consistency reliability was excellent (Cronbach's a =0.77-0.95). To further examine the reliability of the SEIP, test-retest reliability was carried out in 92 patients with cardiovascular disease 50 (42.3%) males mean age=57.7 median=57.0 range=39-78 from five community pharmacies in South Wales and the reliability coefficient was high (rs= 0.91-0.93). Evidence supporting the validity of the SEIP was also shown in 96 patients 49 (51.0%) males mean age=63.1 median=63.0 age rangesss39-84 with a cardiovascular condition from the community pharmacy setting. Convergent validity was demonstrated as SEIP patient scores showed moderate to good correlation with the patient MIDAS (Myocardial Infarction Dimensional Assessment Scale) scores. Divergent validity was established as the Short Form-12 health survey (SF-12) overall score demonstrated weak to moderate correlation with the SEIP scores. This study has established the practicality, reliability and validity of the SEIP as a promising socioeconomic related tool, especially in cardiovascular patients with medication-related problems in the community setting. Future work needs to focus on promoting use of the SEIP as part of the new community pharmacy initiatives in the UK for evaluation of treatment outcomes in patients with medication-related side-effects.