Andrea L. Kjos

A thematic analysis for how patients, prescribers, experts, and patient advocates view the prescription choice process.

BACKGROUND Typically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be worth the cost. OBJECTIVES To learn more about the prescription choice process from several viewpoints, the purpose of this study was to uncover and describe how patients, prescribers, experts, and patient advocates view the prescription choice process. METHODS Data were collected via 9 focus group interviews held between April 24 and July 31, 2007 (3 with patients, 3 with prescribers, 2 with experts, and 1 with patient advocates). The interviews were audiotaped and transcribed. The resulting text was analyzed in a descriptive and interpretive manner. Theme extraction was based on convergence and external divergence; that is, identified themes were internally consistent but distinct from one and another. To ensure quality and credibility of analysis, multiple analysts and multiple methods were used to provide a quality check on selective perception and blind interpretive bias that could occur through a single person doing all of the analysis or through employment of a single method. RESULTS The findings revealed 5 overall themes related to the prescription choice process: (1) information, (2) relationship, (3) patient variation, (4) practitioner variation, and (5) role expectations. The results showed that patients, prescribers, experts, and patient advocates viewed the themes within differing contexts. CONCLUSIONS It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.

The social network paradigm and applications in pharmacy

BACKGROUND There have been calls for research to include contextual and macrolevel factors within explanatory models of human health. A network approach focuses on the influence of relationships to predict behavior. OBJECTIVES The first objective was to describe the social network paradigm based in sociology that uses network principles and methods to visualize, quantify, and predict outcomes using the structure and function of relationships. The second objective was to discuss applications of this approach in the context of health to guide future research in pharmacy. METHODS This was a descriptive overview of conceptual models, methods, measures, and analyses that are used in the social network paradigm. RESULTS The social network paradigm contains conceptual models that rely on relational and structural assumptions to make predictions related to human behavior. Although there is not 1 dominate theory of social networks, several models hold across applications and are commonly used by scholars. The methodology emphasized considerations of network boundaries, sampling strategies, and the type of data collected. Specific variables used in social network analysis were defined and dichotomized into constructs of centrality and cohesion. Network analysis was described in terms of available computational programs, data management, and statistical testing. Related research in health care was applied and ideas for pharmacy were proposed using a social network-based theoretical model. CONCLUSIONS There is growing momentum for health behaviorists to gain familiarity for studying the effect of social networks on behavior. Applications in pharmacy using social network models, methods, and analysis can be used as a stand-alone perspective or in conjunction with other theoretical perspectives in an effort to explain human health or organizational behavior in health care settings.

A drug procurement, storage and distribution model in public hospitals in a developing country

BACKGROUND There is growing interest in pharmaceutical supply chains and distribution of medications at national and international levels. Issues of access and efficiency have been called into question. However, evaluations of system outcomes are not possible unless there are contextual data to describe the systems in question. Available guidelines provided by international advisory bodies such as the World Health Organization and the International Pharmacy Federation may be useful for developing countries like Vietnam when seeking to describe the pharmaceutical system. OBJECTIVE The purpose of this study was to describe a conceptual model for drug procurement, storage, and distribution in four government-owned hospitals in Vietnam. METHOD This study was qualitative and used semi-structured interviews with key informants from within the Vietnamese pharmaceutical system. Translated transcriptions were used to conduct a content analysis of the data. RESULTS A conceptual model for the Vietnamese pharmaceutical system was described using structural and functional components. This model showed that in Vietnam, governmental policy influences the structural framework of the system, but allows for flexibility at the functional level of practice. Further, this model can be strongly differentiated from the models described by international advisory bodies. This study demonstrates a method for health care systems to describe their own models of drug distribution to address quality assurance, systems design and benchmarking for quality improvement.

Communication networks of medication management in an ambulatory care setting

Background: Systems approaches in healthcare address complexities of care related to medication safety. Adverse drug events can be prevented by communication between providers. Thus, methods that depict the structures and processes of communications are foundational for prevention efforts. Social network analysis is a methodology applied in healthcare settings to describe and quantify communication patterns. Knowledge of the structures and processes surrounding medication management communications will be useful to explain and intervene on related quality or safety outcomes. Objectives: The aim of this study was to use social network analysis as a tool to describe the communication structures and processes of medication management for patients on warfarin therapy in an ambulatory care setting. Method: A longitudinal, roster‐based assessment was used for the social network analysis. Data were collected from electronic medical records and coded using a fixed‐list format. Information was collected regarding who was involved as well as frequency and type of communications. The analysis followed 16 subjects at one internal medicine clinic over six months. Results: Structurally, communications were unidirectional and most often connected actors from different groups. Most communications were directed from nursing staff to patients. Central actors were a pharmacist, several nursing staff and one prescriber. Difference in processes were identified by characterizing communications according to level of impact on patient safety. Moderate impact communications corresponded to focused connections between providers. Further, the pharmacist was measured as the most prominent gatekeeper in moderate impact communications compared to an advanced registered nurse practitioner for low impact communications. Conclusions: Medication management reflected a unidirectional and interdisciplinary communication structure that maintained process variation according to the potential impact on patient safety. The level of influence of the pharmacist as a connector in the network rose in conjunction with the level of potential impact the communication had on patient safety.