Creation and validation of a semi-quantitative instrument to assess the confidence of pharmacists in medication consultation for patients with depression: The Pharmacists' Confidence scale about Medication Consultation for Depressive patients (PCMCD)
Objectives: To develop a semi-quantitative instrument to assess pharmacists’ confidence in medication counseling for patients with depression, The Pharmacists' Confidence scale about Medication Consultation for Depressive patients (PCMCD), and investigated its validity.
Methods: Following discussions with practicing pharmacists, we developed a 12-item questionnaire to assess pharmacists’ confidence in medication counseling for patients with depression. We launched web-based cross-sectional survey during November and December 2018 to 77 pharmacists employed at drug chain stores in Kansai area. Factor analysis was performed to evaluate the configuration concept validity. The least-squares method was used for factor extraction, and the resulting factors were subjected to direct oblimin rotation, with a factor loading cut-off of 0.4. To assess internal consistency, Cronbach’s alpha values were calculated for each of the extracted factors (subscales). A multiple regression analysis was performed using simultaneous forced entry, with the scores obtained for each subscale as dependent variables and responder attributes as independent variables in order to investigate the factors associated with each subscale.
Results: During the factor analysis procedure, four questions were excluded by the cut-off rule. Eventually, a model with three subscales was identified, with a cumulative sum of squared loadings being 61.9%. The subscales were termed “relationship building,” “comprehension of condition,” and “information provision” based on the nature of the questions relevant for each of them. The Cronbach’s alpha values for these subscales were 0.92, 0.73, and 0.72, respectively. The average inter-item correlation was 0.378. In addition, multiple regression analysis revealed that there were significant correlations between pharmacist career and both relationship building and information provision.
Conclusions: The PCMCD model demonstrated a satisfactory construct validity and internal consistency. This model will provide an excellent tool for assessing pharmacists’ confidence in depression care.
Ministry of Health, Labour and Welfare, Japan. [Patient Survey 2017]. https://www.mhlw.go.jp/file/05-Shingikai-12201000-Shakaiengokyokushougaihokenfukushibu-Kikakuka/0000108755_12.pdf (accessed Mar 20, 2019).
Demyttenaere K. Compliance during treatment with antidepressants. J Affect Disord. 1997;43(1):27-39. https://doi.org/10.1016/s0165-0327(96)00095-x
Poluzzi E, Piccinni C, Sangiorgi E, Clo M, Tarricone I, Menchetti M, De Ponti F. Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence. Eur J Clin Pharmacol. 2013;69(12):2095-2101. https://doi.org/10.1007/s00228-013-1567-8
Keller MB, Boland RJ. Implications of failing to achieve successful long-term maintenance treatment of recurrent unipolar major depression. Biol Psychiatry. 1998;44(5):348-360. https://doi.org/10.1016/S0006-3223(98)00110-3
McLaughlin KA. The public health impact of major depression: a call for interdisciplinary prevention efforts. Prev Sci. 2011;12(4):361-371. https://doi.org/10.1007/s11121-011-0231-8
Boudreau DM, Capoccia KL, Sullivan SD, Blough DK, Ellsworth AJ, Clark DL, Katon WJ, Walker EA, Stevens NG. Collaborative care model to improve outcomes in major depression. Ann Pharmacother. 2002;36(4):585-591. https://doi.org/10.1345/aph.1A259
Bell JS, Rosen A, Aslani P, Whitehead P, Chen TF. Developing the role of pharmacistrs as members of community mental health teams: perspectives of pharmacists and mental health professionals. Res Social Adm Pharm. 2007;3(4):392-409. https://doi.org/10.1016/j.sapharm.2006.10.005
Al-Jumah K, Qureshi NA. Impact of pharmacist interventions on patients’ adherence to antidepressants and patient-reported outcomes: a systematic review. Patient Prefer Adherence. 2012;6:87-100. https://doi.org/10.2147/PPA.S27436
Rubio-Valera M, Serrano-Blanco A, Magdalena-Belío J, Fernández A, García-Campayo J, Pujol MM, del Hoyo YL. Effectiveness of pharmacist care in the improvement of adherence to antidepressants: a systematic review and meta analysis. Ann Pharmacother. 2011;45(1):39-48. https://doi.org/10.1345/aph.1P429
Canales PL, Dorson PG, Crismon ML. Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting. Am J Health-Syst Pharm. 2001;58(14):1309-1316. https://doi.org/10.1093/ajhp/58.14.1309
Bultman DC, Svarstad BL. Effects of pharmacist monitoring on patient satisfaction with antidepressant medication therapy. J Am Pharm Assoc (Wash). 2002;42(1):36-43. https://doi.org/10.1331/108658002763538053
Finley PR, Rens HR, Pont JT, Gess SL, Louie C, Bull SA, Bero LA. Impact of a collaborative pharmacy practice model on the treatment of depression in primary care. Am J Health-Syst Pharm. 2002;59(16):1518-1526. https://doi.org/10.1093/ajhp/59.16.1518
Adler DA, Bungay KM, Wilson IB, Pei Y, Supran S, Peckham E, Cynn DJ, Rogers WH.The impact of a pharmacist intervention on 6-month outcomes in depressed primary care patients. Gen Hosp Psychiatry. 2004;26(3):199-209. https://doi.org/10.1016/j.genhosppsych.2003.08.005
Capoccia KL, Boudreau DM, Blough DK, Ellsworth AJ, Clark DR, Stevens NG, Katon WJ, Sullivan SD. Randomized Trial of pharmacist interventions to improve depression care and outcomes in primary care. Am J Health-Syst Pharm. 2004;61(4):364-372. https://doi.org/10.1093/ajhp/61.4.364
Rickles NM, Svarstad BL, Statz-Paynter JL, Taylor LV, Kobak KA. Pharmacist telemonitoring of antidepressant use: effects on pharmacist-patient collaboration. J Am Pharm Assoc (2003). 2005;45(3):344-353. https://doi.org/10.1331/1544345054003732
Brook OH, van Hout H, Stalman W, Nieuwenhuyse H, Bakker B, Heerdink E, Haan M. A pharmacy-based coaching program to improve adherence to antidepressant treatment among primary care patients. Psychiatr Serv. 2005;56(4):487-489. https://doi.org/10.1176/appi.ps.56.4.487
Al-Saffar N, Deshmukh AA, Carter P, Adib SM. Effect of information leaflets and counselling on antidepressant adherence: open randomised controlled trial in a psychiatric hospital in Kuwait. Int J Pharm Pract. 2005;13(2):123-131. https://doi.org/10.1211/0022357056181
Crockett J, Taylor S, Grabham A, Stanford P. Patient outcomes following an intervention involving community pharmacists in the management of depression. Aust J Rural Health. 2006;14(6):263-269. https://doi.org/10.1111/j.1440-1584.2006.00827.x
Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, DE Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168-176.
Baba H, Ando M, Kimura I, Shimamura T, Takahashi Y, Nago C, Hayashi Y, Murano T, Saito M. [Influence on medicine instruction of attitudes of pharmacist towards mental illness patient]. Jap J Hosp Commun Psychiat. 2016;58(3):286-295.
Botega NJ, Silveira GM. General Practitioners’ Attitudes Towards Depression: a Study in Primary Care Setting in Brazil. Int J Soc Psychiatry. 1996;42(3):230-237. https://doi.org/10.1177/002076409604200307
Scheerder G, De Coster I, Van Audenhove C. Community pharmacists’ attitude toward depression: A pilot study. Res Social Adm Pharm. 2009;5(3):242-252. https://doi.org/10.1016/j.sapharm.2008.08.008
Haddad M, Walters P, Tylee A. District nursing staff and depression: a psychometric evaluation of Depression Attitude Questionnaire findings. Int J Nurs Stud. 2007;44(3):447-456. https://doi.org/10.1016/j.ijnurstu.2006.07.005
Kerr M, Blizard R, Mann A. General practitioners and phychiatrists: comparison of attitudes to depression using the depression attitude questionnaire. Br J Gen Pract. 1995;45(391):89-92.
Haddad M, Menchetti M, McKeown E, Tylee A, Mann A. The development and psychometric properties of a measure of clinicians’ attitudes to depression: the revised Depression Attitude Questionnaire(R-DAQ). BMC Psychiatry. 2015;15:7. https://doi.org/10.1186/s12888-014-0381-x
Scheerder G, Coster ID, Audenhove CV. Pharmacists’ role in depression care: a survey of attitudes, current practices, and barriers. Psychiatr Serv. 2008;59(10):1155-1160. https://doi.org/10.1176/appi.ps.59.10.1155
Liekens S, Smits T, Laekeman G, Foulon V. A Depression training session with consumer educators to reduce stigmatizing views and improve pharmacists’ depression care attitudes and practices. Am J Pharm Educ. 2013;77(6):120. https://doi.org/10.5688/ajpe776120
Tanaka G, Inadomi H, Kikuchi Y, Ohta Y. Development of an evaluation scale for the ‘Barrier-Free Mind’ Project. In: XIIth World Congress of Psychiatry (CD-ROM). World Psychiatric Association: New York; 2002.
Tanaka G, Ogawa T, Inadomi H, Kikuchi Y, Ohta Y. Effect of an educational program on public attitudes towards mental illness. Psychiatry Clin Neurosci. 2003;57(6):595-602. https://doi.org/10.1046/j.1440-1819.2003.01173.x
Kishimoto K, Toshiya M, Ohiwa S, Yamaura K, Fukushima N. Factors Improving Pharmacists’ Services for Patients with Depression. Jpn J Pharm Health Care. 2016;42(12):795-808. https://doi.org/10.5649/jjphcs.42.795
Park J, Park M. Knowledge, Attitude, and Confidence on Patient Safety of Undergraduate Nursing Students. J Korean Acad Soc Nurs Educ. 2014;20(1):5-14. https://doi.org/10.5977/jkasne.2014.20.1.5
Lindblom-Ylänne S, Trigwell K, Nevgi A, Ashwin P. How approaches to teaching are affected by discipline and teaching context. Stud Higher Educ. 2006;31(3):285-298. https://doi.org/10.1080/03075070600680539
Japan Pharmacist Association. [Guidelines for Working With High-Risk Drugs ver. 2. 2]. Available at: http://www.jshp.or.jp/cont/16/0609-1.pdf
MacCallum RC, Widaman KF, Zhang S, Hong S. Sample size in Factor Analysis. Psychol Method. 1999;4(1):84-99. https://doi.org/10.1037/1082-989X.4.1.84
Kano Y. Does Structural Equation Modeling Outperform Traditional Factor Analysis, Analysis of Variance and Path Analysis? Jpn J Behaviormetrics. 2002;29(2):138-159. https://doi.org/10.2333/jbhmk.29.138
Gosling SD, Rentfrow PJ, Swann WB. A very brief measure of the Big-Five personality domains. J Res Personal. 2003;37(6):504-528. https://doi.org/10.1016/S0092-6566(03)00046-1
Bland JM, Altman DG. Cronbach’s alpha. BMJ. 1997;314(7080):572. https://doi.org/10.1136/bmj.314.7080.572
Piedmont RL. Inter-item Correlations. In: Michalos A. C. (eds) Encyclopedia of Quality of Life and Well-Being Research, Dordrecht: Springer; 2014. https://doi.org/10.1007/978-94-007-0753-5
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475-1483. https://doi.org/10.1001/jama.288.12.1475
Chen P, Ganguli M, Mulsant BH, DeKosky ST. The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry. 1999;56(3):261-266. https://doi.org/10.1001/archpsyc.56.3.261
Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry. 2006;28(5):396-402. https://doi.org/10.1016/j.genhosppsych.2006.05.006
Empana JP, Jouven X, Lemaitre RN, Sotoodehnia N, Rea T, Raghunathan TE, Simon G, Siscovick DS. Clinical depression and risk of out-of-hospital cardiac arrest. Arch Intern Med. 2006;166(2):195-200. https://doi.org/10.1001/archinte.166.2.195
Shoji M, Onda M, Arakawa Y. Effect on Patient Safety of Brief Interventions Performed by Pharmacists via Drug Profile Books: Visualization of Treatment Assist by pharmacists (VISTA) Project in Japan. Pharmacol Pharm. 2016;7(4):176-183. https://doi.org/10.4236/pp.2016.74023
Shoji M, Iwade K, Fujii K, Hirota M, Kanou A, Moriya M, Ishii M, Shimoji S, Onda M, Arakawa Y. [Patient-pharmacist communication using the drug profile book relates to patient’s behavior regarding its use]. Yakugaku Zasshi. 2016;136(10):1427-1431. https://doi.org/10.1248/yakushi.16-00036
Everit BS. Multivariate analysis: The need for data, and other problems. Br J Psychiatry. 1975;126:237-240. http://doi.org/10.1192/bjp.126.3.237
Gorsuch RL. Factor analysis (2nd ed). Hillsdale, NJ: Erlbaum; 1983.
Barret PT, Kline P. The observation to variable ratio in factor analysis. Personal Stud Group Behav. 1981;1(1):23-33.
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