Tan CL, Hassali MA, Saleem F, Shafie AA, Aljadhey H, Gan VB. Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ). Pharmacy Practice 2015 Jul-Sep;13(3):598. doi: 10.18549/PharmPract.2015.03.598 Original Research Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ) Christine L. TAN, Mohamed A. HASSALI, Fahad SALEEM, Asrul A. SHAFIE, Hisham ALJADHEY, Vincent B. GAN. Received (first version): 9-Apr-2015 Accepted: 22-Aug-2015 * ABSTRACT Keywords: Pharmaceutical Services; Health Knowledge, Objective: (i) To develop the Pharmacy Value-Added Attitudes, Practice; Validation Studies as Topic; Services Questionnaire (PVASQ) using emerging themes Questionnaires; Malaysia generated from interviews. (ii) To establish reliability and validity of questionnaire instrument. Methods: Using an extended Theory of Planned Behavior INTRODUCTION as the theoretical model, face-to-face interviews generated salient beliefs of pharmacy value-added services. The The Ministry of Health Malaysia has been striving to PVASQ was constructed initially in English incorporating improve patient oriented pharmaceutical care important themes and later translated into the Malay services to promote health, upgrade the dispensing language with forward and backward translation. Intention system and to increase patients’ satisfaction (INT) to adopt pharmacy value-added services is predicted by attitudes (ATT), subjective norms (SN), perceived towards the services. For chronic diseases, behavioral control (PBC), knowledge and expectations. prescriptions with multiple drugs are usually ordered Using a 7-point Likert-type scale and a dichotomous scale, for more than a month’s supply. Hence, partial drug test-retest reliability (N=25) was assessed by supply will be given for these cases in line with the administrating the questionnaire instrument twice at an Quality Use of Medicines practice in public interval of one week apart. Internal consistency was healthcare facilities.1 Subsequent supply is provided measured by Cronbach’s alpha and construct validity either by the conventional pharmacy counter or between two administrations was assessed using the through the Pharmacy Appointment System in the kappa statistic and the intraclass correlation coefficient (ICC). Confirmatory Factor Analysis, CFA (N=410) was following months until all supplies are fully satisfied. conducted to assess construct validity of the PVASQ. Pharmacy Appointment System is an alternative to Results: The kappa coefficients indicate a moderate to the conventional dispensing system in which almost perfect strength of agreement between test and patients can use mediums such as phone, short retest. The ICC for all scales tested for intra-rater (test- messages, e-mail and fax to inform the date of retest) reliability was good. The overall Cronbach’ s alpha appointment for patient's follow-up medicine (N=25) is 0.912 and 0.908 for the two time points. The supplies. result of CFA (N=410) showed most items loaded strongly and correctly into corresponding factors. Only one item Pharmacy value-added services in Malaysian was eliminated. context can be defined as any pharmacy activities Conclusions: This study is the first to develop and or practices introduced or initiated by pharmacists establish the reliability and validity of the Pharmacy Value- (or pharmacy staff) through innovation and creativity Added Services Questionnaire instrument using the Theory of Planned Behavior as the theoretical model. The to improve the delivery of pharmaceutical care to translated Malay language version of PVASQ is reliable patients. The objective of the pharmacy value- and valid to predict Malaysian patients’ intention to adopt added services in the Malaysian public health sector pharmacy value-added services to collect partial medicine is to facilitate refill of medications, to reduce waiting supply. time and to increase patient convenience.2 The most common pharmacy value-added services in Malaysia are Integrated drug dispensing systems, drive through pharmacy, medicines by post * 1Malaysia (UMP 1Malaysia), SMS and take, Email Christine L. H. TAN. Discipline of Social and and take, Telephone and take, Fax and take and Administrative Pharmacy, School of Pharmaceutical Appointment card. Sciences, Universiti Sains Malaysia. Penang (Malaysia). [email protected] Pharmacy Value-Added Services in Malaysia Mohamed Azmi Ahmad HASSALI. Discipline of Social and Administrative Pharmacy, School of Pharmaceutical One of the most recommended pharmacy value- Sciences, Universiti Sains Malaysia. Penang (Malaysia). added services is the Pharmacy drive through [email protected] service. This service provides monthly partial Fahad SALEEM. Discipline of Social and Administrative supplies to patients via the drive through pharmacy Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang (Malaysia). [email protected] counter. Patients are given an appointment date Asrul Akmal SHAFIE. School of Pharmaceutical prior to drug collection. On the scheduled date, Sciences, Universiti Sains Malaysia. Penang (Malaysia). patients will collect their partial medicine supplies at [email protected] drive through pharmacy counter only. However, if Hisham ALJADHEY. College of Pharmacy, King Saud patients wish to switch to other pharmacy value- University. Riyadh, (Saudi Arabia). [email protected] added services in near future, they are allowed to Vincent B. Y. GAN. Putra Business School, Universiti do so without any processing charges. However, Putra Malaysia. Selangor (Malaysia). patients must inform the pharmacist earlier to allow [email protected] www.pharmacypractice.org (ISSN: 1886-3655) 1 Tan CL, Hassali MA, Saleem F, Shafie AA, Aljadhey H, Gan VB. Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ). Pharmacy Practice 2015 Jul-Sep;13(3):598. doi: 10.18549/PharmPract.2015.03.598 time to transfer personal files from one service implemented the first drive-through pharmacy center to another. service in Taiwan in July 2011, opening a four-lane drive-through near the hospital building.3 The Besides drive through pharmacy, medicine by post implementation of the Shuang Ho Hospital drive- 1Malaysia which is known as UMP 1Malaysia was through service increased the overall prescription initiated to deliver monthly medications to patients refilling rate, online reservation usage and designated destination via postal service with a proportion of medications picked up within a six nominal postal fee being imposed to the patient by month period. In Australia, one-stop-shop, forward Pos Malaysia. UMP 1Malaysia main objectives are dispensing, “Rolls Royce service”, e-prescribing, to eliminate patient’s waiting time in clinic, promote chronic illness card, prescription reminder systems, continuation of medications to patients and to drive-through, pick up and home delivery services increase drug compliance in patients. This service is are a few examples of the innovations and free of any administrative or pharmaceutical service expectations of consumers from their community charges. pharmacies.4 E-prescribing which supplies Integrated drug dispensing system is another prescription via online system is highly demanded dispensing system whereby patients are allowed to by Australian patients as this system is viewed to refill their partial supplies freely from any reduce pharmacy queues and prescription related 4 government health facilities that are listed under the paperwork. At the same time, more and more Ministry of Health Malaysia Integrated Drug consumers prefer home delivery services and drive- Dispensing System Directory throughout Malaysia. through services over face-to-face or going-into- 5 This system enables patients to refill their pharmacy medicine pick-up in Australia. subsequent medication supply in facilities mostly In the United States, outpatient drugs are dispensed conveniently located to their home, office or through both community and mail order villages. pharmacies.6 Mail order pharmacy services The SMS and take is another service provided for historically existed primarily for delivery of 7 patients who want to collect follow-up medication in medication to rural or remote areas. Pharmacy government healthcare system. This service benefit managers through expanded services requires patients to send short messages (SMS) routinely offer drug formulary development, about their details and the desired date and time of specialty pharmaceutical distribution and mail order collections to the pharmacist in charge. Upon arrival prescription delivery options to clients to control 8 at the counter, the patients only need to show their prescription drug cost. Instead of widespread prescription numbers and collect the supply without perception of lower prices via mail order versus having to queue or pay a service fee. This initiative community pharmacies, several studies have was pioneered to reduce waiting time, increase discovered mixed and opposite findings regarding delivery performance and improve patient the potential savings in cost to both patients and 8,6 satisfaction. insurers. Instead, some generic drug prices are higher through mail order pharmacy. It is also found Generally, patients who are clinically stable, on long that the loss of copayments in mail order service term medications, well-counselled and not taking benefit was greater