Development and validation of a survey instrument to measure factors that influence pharmacist adoption of prescribing in Alberta, Canada

Abstract

Objective:Study objectives were to develop a questionnaire to assess factors influencing pharmacists’ adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties.Methods:Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach’s alpha. Scale responses were described.Results:Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support from interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliability while the remaining six scales had strong evidence for reliability and validity.Conclusion:Through a multi-stage process, a survey instrument was developed to capture pharmacists’ perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists.

The Excellence of Pharmacy Practice

“…Albertan pharmacists do not require a written agreement with a physician to prescribe as in the US model. Furthermore, pharmacists do not require additional training with a physician partner as in the UK model [ 64 ]. National Center for Health Workforce Analysis, sponsored by the Health Resources and Services Administration, projected that between 2012 and 2025 the pharmacist supply, adjusting for new entrants as well as exit from the labor force demand would increase by 16%.…”

Training Needs of Manitoba Pharmacists to Increase Application of Assessment and Prescribing for Minor Ailments into Practice: A Qualitative and Quantitative Survey

“…Isenor et al described time, staffing, and reimbursement as barriers identified to fully adopting prescribing. Guirguis et al described limitations in the practice environment including staffing [ 29 , 30 ]. While pharmacists are one of the most accessible primary care health care providers, based on the number of patient visits compared with primary care physicians, a limited range of prescribing authority combined with lack of appropriate remuneration potentially impacts patient perception of the pharmacist’s role and the pharmacist’s full adoption of services into practice [ 31 ].…”

Prescription Modification by Pharmacists in a Hospital Setting: Are Ontario Pharmacists Ready?

“…An existing survey instrument with evidence for reliability and validity was developed by Guirguis and others 19 for the purpose of measuring factors that influence pharmacists' adoption of prescribing in Alberta, Canada. We contacted the authors of that survey instrument and obtained permission to adapt their survey instrument to address our primary objective.…”

“…We contacted the authors of that survey instrument and obtained permission to adapt their survey instrument to address our primary objective. For our Likert-type questions, we adapted 3 of the 8 scales with strong evidence for reliability and validity from the survey instrument by Guirguis and others, 19 including questions about self-efficacy, support from the practice environment, and support from interprofessional relationships (for the complete survey, see Appendix 1, available at https://www.cjhp-online.ca/index .php/cjhp/issue/view/ 205). We included additional qualitative open-ended questions to address one of our secondary objectives.…”