Identifying the important outcomes to measure for pharmacy-led, clinical services within primary care: a nominal group technique approach

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Abstract

Background
The introduction of clinical pharmacy services is part of a multi-disciplinary approach to reduce pressure on primary care. Ascertaining the impact of clinical pharmacists in general practice is vital to ensure intended benefits are achieved. However, this is complicated by poor quality evidence, multiple interventions, and a lack of agreement regarding outcome measures.

Objectives
To develop an outcomes framework for clinical pharmacy services delivered in Scottish general practice using a consensus methodology.

Methods
A modified nominal group technique (NGT) was conducted using Microsoft Teams and Qualtrics. This involved a pre-NGT questionnaire, silent generation of ideas, round robin, discussions, ranking, and a final consensus exercise. A selective sampling strategy recruited experienced pharmacists from Scottish health regions. NGT ranking results were used to signify relative importance of the outcome areas. NGT discussions underwent inductive thematic analysis to explore key areas considered.

Result
Overall, 13 (median: 24 years of experience) pharmacists participated, representing 11 of 14 Scottish regions. In total, 21 outcome areas, derived from the literature and a pre-NGT questionnaire, were considered during the NGT ranking exercise. Consensus identified five important outcome areas: Patient Experience, Medication Related Adverse Events, Cost-Effectiveness, Medication Optimisation, and Health Related Quality of Life. Thematic analysis highlighted the importance of the outcome framework's target audience, factors influencing the interpretation of outcomes, and the feasibility of the associated outcome measures.

Conclusions
The five key outcome areas will facilitate evidence-based decisions regarding service delivery. Future work should develop a measurement plan, involving routinely collected sources of outcomes data. The feasibility of collecting outcomes in the real-world context should be considered, identifying measures which are easy to collect within existing data infrastructures. This paper describes a replicable method to gain consensus for a national approach to data collection from a strong theoretical basis using an online methodology.
Original languageEnglish
Pages (from-to)468-476
Number of pages9
JournalResearch in Social and Administrative Pharmacy
Volume19
Issue number3
Early online date11 Nov 2022
DOIs
Publication statusE-pub ahead of print - 11 Nov 2022

Keywords

  • outcome measurement
  • primary care
  • pharmacy services
  • pharmacotherapy
  • nominal group technique
  • consensus methods

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