Jul-Sep, 2012 - Indian Journal of Pharmacy Practice

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Rao JR - Development and Validation of an Instrument to Assess the Perception of Pharmacy Students' on Medication Review ProcessTable 4: Factor loading of the itemsS.NO Item No. Item Factors1 2 31. 4 Conducting Medication Review improves the intervening capability of 0.539pharmacist2. 6 Medication Review improves patient compliance and health status 0.6123. 7 Medication Review ensures safe and cost effective therapy to the patient 0.7454. 8 Medication Review optimizes polypharmacy prescriptions 0.6665. 9 Medication Review ensures appropriateness of therapy through detection 0.455and prevention of drug related problems6. 12 Medication Review considers Medication History Interview (MHI) and 0.454Medication reconciliation to ensure therapeutic individualization7. 10 There is a need for Structured format to conduct Medication Review 0.8118. 11 There is a need of specific training to conduct and document 0.814medication review9. 13 Medication Review requires lot of Time and Effort to learn and practice 0.43610. 1 Medication Review is necessary to be conducted by all clinical pharmacists 0.65311. 2 Medication Review is professionally rewarding and valuable to one's career0.53512. 3 Medication Review is useful in improving communication with Patients0.64as well as health care professionals13. 5 Medication Review is a core requirement of Pharmaceutical care 0.445Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization.(Factor loadings: > 0.4 significant and > 0.5 very significant)DISCUSSIONThe present study is an attempt to analyze perception ofmedication review by the pharmacists in India. An instrument(MeRPA) was developed to assess the medication reviewperception and the reliability and factor validity were tested.In a study conducted by MacIntosh et al a tool was developedto measure the pharmacist's attitudes and barriers ofproviding medication review. In this MacIntosh's study,Respondents agreed that Medication therapy management(MTM) services would be perceived valuable by patients,improves clinical outcomes. Survey results includespharmacists are more appropriate to provide MTM service[16]especially trained personnel. Respondents of the presentstudy also expressed positive opinion on medication reviewservice and considering it as necessary to be conducted byclinical pharmacists and useful in improving communicationwith patients and health care professionals.In a study conducted by Latif and Boardman with a developedquestionnaire to explore the attitude of communitypharmacists towards medication use review service theyfound that pharmacists felt, lack of time and non-availability19of support staff as barriers to medication review. Fewrespondents in the present study also felt the lack of time as aconstraint. According to respondents of Latif and Boardmanstudy respondents of the opinion, MURs were an opportunityfor pharmacist to improve the skill, practice the profession19and to provide better service to patients.Respondents had excellent understanding on medicationreview process. No significant association was foundbetween age, sex and level of education in perception ofmedication review. In this survey, the year of study had asignificant impact in perception of medication review.PharmD IV year students had significantly betterunderstanding on medication review process compared tofinal year B.Pharm, first year M.Pharm and second and thirdyears of PharmD courses. As these students were the firstbatch in India, their eagerness and readiness to be a member ofhealth care team, has led them to perceive the medicationreview at extreme levels.Chronbach alpha value 0.82 explains that the reliability of theresponses to the items was good. Three factors were emergedthrough factor analysis; named as Professional need of MR,Benefit of MR and Requirement of MR according to the itemsloaded under each factor.The developed instrument can be used to assess themedication review perception. The reliability and constructvalidity of the instrument were found, which givesinformation regarding impact of motivation and clinicalIndian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 73
Rao JR - Development and Validation of an Instrument to Assess the Perception of Pharmacy Students' on Medication Review Processcourses on individual students, training need of medicationreview. The information from this study will be used forchecking training needs.LimitationsMedication Review Perception Assessment Instrumentrequires cross validation. Survey should be conducted instudents and the working clinical pharmacists of variousregions to strengthen the validity of the MeRPA instrument.Convergent validity was not assessed for this instrument.CONCLUSIONThis study is the first of its kind in India to assess theperception of pharmacy students towards medication reviewusing a standard instrument. Respondents had enoughknowledge to understand the medication review processoutcomes. At about 96% of the respondents agreed to thenecessity of conducting medication review by all clinicalpharmacists. About 91 % of respondents felt that medicationreview is useful in improving communication skills ofpharmacist. These results shows that medication reviewprocess can become a part of all the practicing pharmacists'responsibilities provided they were given with adequatetraining and resources.ACKNOWLEDGEMENTSThe author wish to acknowledge all the respondents of thestudy and also, Manipal University, Manipal, India for havingprovided with the necessary support.References:1. Task force on medicines partnership and the nationalcollaborative medicines management services programme.Room for review: a guide to medication review: the agenda forpatients, practitioners and managers. London: MedicinesPartnership; 2002. http://www.npc.co.uk/med_partnership/assets/room_for_review.pdf.2. Hepler CD, Strand LM. Opportunities and Responsibilities inPharmaceutical Care. Am J Hosp Pharm 1990;47:533-43.3. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical CarendPractice: The Clinician's Guide. 2 ed. New York, NY:McGraw-Hill; 2004: 119-170.4. Pharmaceutical Services Negotiating Committee. MURs: thebasics. What is the Medicines Use Review and PrescriptionIntervention Service? 2008. http://www.psnc.org.uk/pages/murs_the_basics.html .5. Clyne W, Blenkinsopp A, Seal R, Plus N. A Guide to MediccrtionReview 2008. rn. 2008;500:9.6. Lee E, Braund R, Tordoff J. Examining the first year ofMedicines Use Review services provided by pharmacists inNew Zealand: 2008. NZ Med J. 2009;122:3566.7. Lipton HL, Bero LA, Bird JA, McPhee SJ. The impact of clinicalpharmacists' consultations on physicians' geriatric drugprescribing: a randomized controlled trial. Medical Care.1992:646-58.8. Howard RL, Avery AJ. Pharmacist-led medication reviews canreduce patient morbidity? Age and Ageing. 2006;35(6):555.9. Niquille A, Lattmann C, Bugnon O. Medication reviews led bycommunity pharmacists in Switzerland: a qualitative survey toevaluate barriers and facilitators. Pharmacy Practice (Internet).2010:35-42.10. Zermansky AG, Petty DR, Raynor DK, Freemantle N, VailA,Lowe C. Clinical medication review by a pharmacist of elderlypatients on repeat prescriptions in general practice: arandomized controlled trial. BMJ 2001; 323: 1340-3.11. Zermansky AG, Alldred DP, Petty DR, Raynor DK, FreemantleN, Eastaugh J, et al. Clinical medication review by a pharmacistof elderly people living in care homes—randomised controlledtrial. Age and Ageing. 2006;35(6):586.12. Rovers J, Miller MJ, Koenigsfeld C, Haack S, Hegge K,McCleeary E. A Guided Interview Process to Improve StudentPharmacists' Identification of Drug Therapy Problems.American Journal of Pharmaceutical Education. 2011;75(1).13. Holland R, Smith R, Harvey I. Where now for pharmacist ledmedication review? Journal of epidemiology and communityhealth. 2006;60(2):92.14. Narayana T.V. Pharmacy education in India. Pharma Times.Mar 2011; Vol.43(3).15. Basak SC, Sathyanarayana D. Pharmacy education in India.Am J Pharm Educ. 2010;74(4):Article 68.16. MacIntosh C, Weiser C, Wassimi A, Reddick J, Scovis N, GuyM, et al. Attitudes toward and factors affecting implementationof medication therapy management services by communitypharmacists. Journal of the American Pharmacists Association.2009;49(1):26-3017. George, D., and Mallery, P. (2003). SPSS for Windows step bystep: A simple guide and reference. 11.0 update (4th ed.).Boston: Allyn and Bacon.18. Rencher AC. Methods of multivariate analysis: Wiley OnlineLibrary; 1995.19. Latif A, Boardman H. Community pharmacists' attitudestowards medicines use reviews and factors affecting thenumbers performed. Pharm World Sci. 2008;30(5):536-43.Indian Journal of Pharmacy Practice Volume 5 Issue 3 Jul - Sep, 2012 74
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