ORIGINAL RESEARCH

 

Exploring consumer understanding and preferences for pharmacy quality information

Explorando comprensión y preferencias sobre la calidad de la información en farmacia

 

 

Olayinka O. Shiyanbola¹ and Jane R. Mort²

¹ PhD. Assistant Professor. Division of Social and Administrative Sciences, University of Wisconsin-Madison. Madison, WI (United States). oshiyanbola@pharmacy.wisc.edu
² PharmD. Professor. Department of Pharmacy Practice, South Dakota State University. Brookings, SD (United States). Jane.mort@sdstate.edu

This study was funded by the Community Pharmacy Foundation.

 

 

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ABSTRACT

Objective: To describe consumer understanding of pharmacy quality measures and consumer preferences for pharmacy quality information.
Methods: Semi-structured focus group design was combined with survey methods. Adults who filled prescription medications for self-reported chronic illnesses at community pharmacies discussed their understanding of Pharmacy Quality Alliance approved quality measures. Questions examined preference of pharmacy quality information rating systems (e.g. stars versus percentages) and desired data display/formats. During the focus group, participants completed a survey examining their understanding of each pharmacy quality measure. All focus group discussions were transcribed verbatim. Data were analyzed using thematic analysis and descriptive statistics.
Results: Thirty-four individuals participated (mean age= 62.85; SD=16.05). Participants were unfamiliar with quality measures information and their level of understanding differed for each quality measure. Surveys indicated 94.1% understood "Drug-Drug Interactions" and "Helping Patients Get Needed Medications" better than other measures (e.g., 76.5% understood "Suboptimal Treatment of Hypertension in Patients with Diabetes"). Qualitative analysis indicated participants preferred an overall pharmacy rating for quick access and use. However, participants also wanted quality measures information displayed by health conditions. Participants favored comparison of their pharmacy to city data instead of state data. Most participants liked star ratings better than percentages, letter grades, or numerical ratings.
Conclusions: Individuals who have a chronic illness and regularly use community pharmacies are interested in pharmacy quality measures. However, specific quality measures were not understood by some participants. Participants had specific preferences for the display of pharmacy quality information which will be helpful in the design of appropriate quality report systems.

Key words: Quality Assurance, Health Care; Consumer Satisfaction; Community Pharmacy Services; Pharmacies; United States.

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RESUMEN

Objetivo: Describir la comprensión sobre las medidas de calidad de la farmacia y las preferencias del consumidos por la información sobre calidad de la farmacia.
Métodos: Se combinó un método de grupo focal semi-estructurado con una entrevista. Los adultos que presentaban una receta de medicación para una enfermedad crónica auto-reportada en farmacias comunitarias discutieron su comprensión de las medidas de calidad aprobadas por la Pharmacy Quality Alliance. Las preguntas examinaban las preferencias sobre los sistemas de información de clasificación de la calidad de farmacia (p.e. estrellas contra porcentajes) y los formatos/presentaciones de datos deseados. Durante la participación en los grupos focales, los participantes cumplimentaron un cuestionario que examinaba su comprensión de cada medida de calidad de farmacia. Todas las discusiones de los grupos focales fueron transcritas literalmente. Se analizaron los datos usando un análisis temático y estadística descriptiva.
Resultados: Participaron 34 individuos (edad media=62,85; DE=16,05). Los participantes no estaban familiarizados con las medidas de calidad de la farmacia y su nivel de comprensión variaba entre las diferentes medidas. Las encuestas indicaron que el 94,1% entendía "Interacciones medicamento-medicamento" y "Ayudar al paciente a que obtenga las medicinas que necesita" mejor que otras medidas (p.e. 76,5% entendía "Tratamiento sub-optimo de la hipertensión en pacientes con diabetes"). El análisis cualitativo indicó que los participantes preferían las calificaciones generales de la farmacia para un acceso y uso rápido. Sin embargo, los participantes también querían información de las medidas de calidad expuestas por problemas de salud. Los participantes estaban a favor de su farmacia con los datos de la ciudad, en lugar de con los datos del estado. A la mayoría de los participantes les gustaban las calificaciones de estrellas más que los porcentajes, calificaciones por letras o calificaciones numéricas.
Conclusiones: Los individuos que tienen una enfermedad crónica y usan regularmente una farmacia comunitaria están interesados en medidas de calidad de la farmacia. Sin embargo, algunos participantes no entendían las medidas de calidad de la farmacia. Los participantes tenían preferencias específicas para la exposición de la información de la calidad de la farmacia que serían útiles para ayudar en el diseño de sistemas idóneos de información de calidad.

Palabras clave: Garantía de la Calidad de Atención de Salud; Satisfacción de los Consumidores; Servicios de Farmacia Comunitaria; Farmacias; Estados Unidos.

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Introduction

Performance information of health care systems, health care providers, and health organizations has been increasingly made available to the public over the past decade.¹ The release of provider performance information to the public has been justified for several reasons: i) An expectation that this information will allow consumers to choose and inquire about high quality providers^2-5, ii) Health care providers can use the data as a viable marketing tool⁶, iii) Cost will be contained and/or less likely to be the principal influence on the consumer´s selection of a provider^7,8, and iv) Such information will be a useful tool for ensuring provider accountability and/or increase health provider´s motivation to improve.⁹ Though the possibility is promising, there are presently no publicly available quality reports designed and disseminated for use by the pharmacy consumer.

Pharmacy-based quality measures have been developed by the Pharmacy Quality Alliance (PQA), a United States consensus-based non-profit organization established in 2006 to lead pharmacy involvements in health care quality initiatives. The goal of PQA is to develop medication use measures based on available claims data and report the results meaningfully to consumers, pharmacists, employers, health plans, and others. It has been suggested that pharmacy quality indicators may benefit pharmacy management and health care organizations that seek to use such performance data to identify quality improvement opportunities and/or change their organizational policies and procedures. In addition, pharmacy indicators may be used by regulatory or accrediting bodies to determine reaccreditation or recertification of healthcare organizations, used by payers to determine provider payments (e.g. pay for performance) and finally used by patients to determine what providers to use. Despite the potential benefits to consumers, limited work has been carried out to determine how this information could be communicated and made understandable to the consumer.^10,11

Research has examined how consumers make sense of quality information. To communicate quality information to consumers, it is important to use consumer preferences to determine what measures should be included in performance reports.¹² In addition, the importance of utilizing patients´ understanding of quality measures in the development and advancement of quality measures has been documented. When consumers don´t understand the quality information being presented in a reporting system, they are likely to dismiss the information, even when it clearly reflects a significant measure of quality. Conversely, consumers sometimes rely on patient satisfaction ratings that seem better understood than less- understood objective clinically based measures of quality.¹² Jewett and Hibbard (1996) showed that quality measures are not well understood by consumers at either a simple or more theoretical level of comprehension.¹³ Noted comprehension problems include a lack of understanding of the terminology, a lack of understanding of the assessments (whether low or high rates of a measure indicate good quality), and not being able to comprehend what a quality measure is supposed to indicate about quality of care.¹²

According to a proposed consumer choice model, a series of events need to take place in order to facilitate the use of comparative quality information by consumers.¹⁴ This includes: an awareness and understanding of the information, perceived usefulness of the information and the ability to use the information in decision-making. Knowledge (the ability to correctly interpret quality information, understand the information, and be knowledgeable of the quality scoring system), attitude (trust, appreciation, value, and use of quality information), and behavior (selecting or switching a healthcare provider) are similarly important in the consumer choice model.¹⁵ This study explores the potential use of pharmacy quality measures by consumers using this model.

Consumer understanding and preferences for quality measures has great implications in the design, content and format of report cards, especially in the pharmacy setting where limited work has been done. Research to understand consumer preferences of quality information are needed as an important step in increasing consumer participation in pharmacy selection decision-making.

In a previous study, lay consumers reported limited knowledge and understanding of PQA pharmacy-based measures, drug names and terminologies related to quality performance information.¹⁶ However, some of these consumers were not taking medicines, did not have a chronic illness and did not necessarily use a community pharmacy to fill prescriptions. Hence, they were not representative of consumers who would be interested in using pharmacy quality measures to choose pharmacies. This present study further explores the potential use of pharmacy quality information by individuals who regularly utilize community pharmacies. This study is significant in informing the process of making pharmacy quality information available to community pharmacy users. The objectives of this study were to 1) Describe consumer understanding of pharmacy quality measures and 2) Describe consumer preferences for pharmacy quality information.

 

Methods

Design

The design of this study was cross-sectional using semi-structured focus groups and surveys as the method for data collection. Both data collection methods were used because of the newness of the topic which requires qualitative exploration of patient perceptions and may not be effectively captured by a single questionnaire or survey. In addition, patient perceptions of quality measures from both a qualitative and quantitative perspective provides a more complete understanding of pharmacy quality measures, allows the addition of information about study participants and facilitates the comparison of participants´ contextual information with their survey responses.

Sample

The sample included adult men and women who could speak and understand English. Participants had to be diagnosed with a chronic illness by their health provider, currently using a community pharmacy to fill prescriptions and currently taking a prescription medication. The convenience sample was recruited from a rural and urban geographical location using newsletters, flyers, radio announcements and word of mouth from participants. Human subjects study approval was received by the investigators´ university institutional review board.

The Focus Groups

Focus Groups lasting about 60 to 90 minutes assessed consumers´ understanding and preferences for pharmacy quality measures information. The groups were held from January to May 2013 with four to six participants in each group. Best practices for conducting focus groups were followed during the discussion.¹⁷ Participants discussed their understanding and interpretation of each quality measure by examining the language and meaning of the measures. Also, participants discussed their rating preference for quality information (e.g. the use of stars versus the use of percentages), their preferred method for the data display of quality ratings (e.g. the use of bar graphs) and the format of presenting quality information. In addition, mock report cards were used by participants to discuss their preferences for pharmacy report cards. Snapshots of a Medicare Part D (Medicare prescription drug benefit plan) comparison quality information available on the internet was shown to participants as an example of a performance rating system (See Appendix). Participant reactions to the format and display of the quality information were documented. Open-ended neutral questions were used in all discussions and these questions were developed by the research team with feedback and input from a collaborator at PQA. The focus group script had been used and tested in our previous pilot study and was modified to fit the objectives of this study.¹⁶ The specific questions were based on the objectives of the study and there was minimal deviation from the script during the administration of each focus group. The project collaborator at PQA provided the consumer-friendly phrasings and definitions of the pharmacy quality measures (Table 1). The pharmacy quality measures that were presented to the participants in this study included:

1. Helping Patients Get Needed Medications
2. Diabetes Medication Dosing
3. Use of High-Risk Medications in the Elderly
4. Drug-Drug Interactions
5. Suboptimal Treatment of Hypertension in Patients with Diabetes
6. Absence of Controller Therapy for Persons with Asthma.

 

 

The focus group discussions were audio recorded using a digital recorder. The principal investigator or Research Assistant moderated the sessions. Focus groups were conducted in an urban and rural area of a Mid-Western State in the United States. The urban location is the largest city in the state with a population of about 150,000 people while the rural location is a small rural town of about 3,000 people.

The Surveys

Two surveys were administered to the participants. At the beginning of the focus group, a brief 5-minute survey was administered to participants. The questionnaire collected information on participants´ socio-demographic and clinical characteristics including age, gender, race/ethnicity, years of school completed, self-rated health (response options from poor to excellent), current use of prescription medications (Yes/No), number of prescription medications, number of pharmacies used in the previous six months, number and the type of chronic illness, and type of health insurance plan. Information on participants´ use and access to the web/internet were also obtained. For example, specific questions on participants´ primary site for the use of the web, availability of internet access at home (Yes/No), type of home internet connection, and frequency of the use of the internet were included in the survey. During the focus groups, participants were given survey worksheets to complete. Using response options of Yes/No, questions related to consumers´ understanding of each pharmacy quality measure were examined. Specifically, participants indicated if they understood the meaning of each specific measure. All participants were identified using identifier numbers. Each participant received a USD20 gift card as compensation for their participation in the study.

Analysis

Audio recordings of the focus group discussions were transcribed verbatim by a certified transcriber. Thematic analysis was used to examine consumers´ understanding of pharmacy quality measures and consumer preferences for pharmacy quality information including data formatting and data display.¹⁸ Other emergent themes related to access and dissemination of pharmacy quality information was also examined. The participants´ statements from transcribed notes were used to explore themes and subthemes. Then, using the focus group questions, final themes were obtained. Additional themes that emerged from the discussions were also noted. Three researchers (the investigator and two research assistants) coded the transcripts individually and the results from each coder were compared to assure consistency. The thematic analysis followed best practices by incorporating both a data-driven inductive approach and a deductive a priori template of coding using the study research objectives and focus group questions.^18,19 Descriptive statistics examined the frequencies and means of all consumer characteristics and survey questions on understanding of quality measures. All quantitative data were analyzed using SPSS version 21.0.

 

Results

There were 34 participants in this study with a mean age of 62.85 years (SD=16.05). Most participants were female (n=26, 76.5%) and white (n=31, 91.2%). (Table 2). Two major themes and three emergent themes were identified from the focus groups. The major themes were 1) Consumers´ understanding of pharmacy quality measures differed by the type of measure and 2) Consumers´ had specific preferences for the display of pharmacy quality information. Additional themes emerged during the focus group discussion (Table 3).

Objective 1

Consumer understanding differed by the type of measure. Measures such as Diabetes Medication Dosing, Suboptimal Treatment of Hypertension in Patients with Diabetes, and Absence of Controller Therapy for persons with Asthma was difficult for participants to comprehend. Similar to the focus groups, the survey responses showed that Suboptimal Treatment of Hypertension in Patients with Diabetes and Absence of Controller Therapy in Persons with Asthma had the lowest percentages of participants who understood the measure, 76.5% and 79.4% respectively. (Table 4)

Consumers thought the explanation of each measure in parenthesis helped them to understand the measure. Participants explained that some of the measures were hard to understand because of complex wordings (due to high grade reading level). Also, some of the measures were hard to understand because of consumers´ non-familiarity with the type of information presented. Consumers want plain language in the communication of quality information (Table 3).

Objective 2

Participants had specific preferences for the display of pharmacy quality information including data display, data formatting and important pharmacy quality information (Table 3).

Data display. Most participants liked the star system better than percentages, letter grade or numerical ways of rating. Some participants did not care what grade system was used as long as the criteria was understood and the measures were clear. "A lot of times those ratings systems are like a five star or something like that. You don´t always know what the criteria are. So, I think it would be important for people to understand what they were measured on, rather than just be five stars or whatever"

Consumers did not like the inclusion of a state average in the mock reports nor the comparison of the pharmacy rating to the state average. Instead, consumers favored a comparison of their pharmacy to city data instead of state data. "I think there´s a whole lot of too much information (in reference to state data)…Well, I think you have to realize most of us elderly now just have high school and very little college…We get too much information thrown at us…"

Data formatting. Consumers would like to see a pharmacy score with an overall pharmacy rating displayed for quick access and use. Consumers also wanted to see quality measures information displayed by certain health conditions. "I feel like something like this (data broken down by health condition) would be a good secondary supplemental information to a broader visual rating. Or let's say you had just like an overall like composite general thing for people who want just a general knowledge"

Additional themes

Interest in pharmacy quality information. Participants were interested in publicly available pharmacy quality information and would access quality information if available. Consumers noted that they want their pharmacies to be rated. "Would you ever find anybody that doesn´t want to have their pharmacy rated? I can´t imagine anybody not wanting to know whether their pharmacy was doing what they´re supposed to be doing"

Participants stated that they would ask their pharmacist about the quality ratings. Also, they noted that they would ask for pharmacy quality information if they were educated on the content. "I would think once you´re educated, if you know what´s out there, you´re going to ask for it"

Inclusion of other pharmacy information in quality reporting systems. In addition to quality measures information, participants wanted to see other pharmacy information including their service, patient satisfactions and cost of medications (Table 3).

Some individuals were hesitant about including consumer satisfaction information in pharmacy quality reports. "The science part would be objective if they were making mistakes or something like that. Consumers are just personal opinions"

Consumers also indicated they may pay more for the price of quality. A participant said:

"Cost is important. I think that (this information) should be there. Things could be a lot cheaper but the quality isn´t there. I want to make sure the quality is there if I´m going to pay. For more money, if the quality is better, I would pay the difference. Your life is worth more than money"

Access to pharmacy quality information. Participants mostly wanted to use the internet to access quality information but also wanted the information available to individuals who had no access to the internet. "I think we should have choices, you know, for those who want to go on the Internet. The world is automatically thinking everybody´s got a computer. But not everybody does"

Participants also wanted quality information placed at the pharmacy and wanted to be able to inquire about pharmacy quality information from their doctor´s office (Table 3).

Criteria for rating pharmacies. Some participants thought that the quality measures presented during the focus group were not appropriate for rating pharmacies. A participant said "Oh, I could give you criteria to rate a pharmacy. But I don´t think these-I wouldn´t use these criteria"

 

Discussion

This study showed that consumers´ understanding of pharmacy quality measures may differ by the type of measure being examined, and pharmacy users have particular preferences for the display and formats of pharmacy quality information. The findings also reveal that individuals who regularly use community pharmacies are interested in public reports of pharmacy quality information and would seek quality information, if available. A strength of this study is the utilization of pharmacy users with varying chronic conditions.

Suboptimal Treatment of Hypertension in Patients with Diabetes and Absence of Controller Therapy in Persons with Asthma were understood by the smallest percentage of patients while other measures including Drug-Drug Interactions, Helping Patients Get Needed Medication, Use of High Risk Medication in the Elderly, and Diabetes Medication Dosing were understood by a larger portion of the participants. It is possible that Absence of Controller Therapy and Suboptimal Treatment of Hypertension in Patients with Diabetes were the least understood quality measures because these two measures refer to the percentage of negative events occurring in the patient population (as defined in the study) while the other measures refer to the pharmacy ensuring positive, high-quality care. In other words, the four measures that were better understood may have been perceived as positive procedures (the pharmacy making sure patients receive optimal treatment) and the two measures with less understanding may have been perceived as negative events (the percent of pharmacy patient´s not getting optimal treatment).

Some of the measures were difficult to understand because of the complexity of wording (written at a higher grade reading level). An understanding of the specific quality measure might be based on the plain language utilized in describing the measure. Previous research suggests that using simple language as an approach to communicating quality information is the most effective way of sharing such information with consumers.^16,20,21 A barrier to the use of quality information by consumers is a lack of understanding of the information.^1,22 Before pharmacy quality measures can be used in provider selection, the information has to be understandable, then consumers would be able to use the information presented in quality reports.^23,24

Consumers explained that some of the measures were hard to understand because of their non-familiarity with the type of information presented. In a previous study, lay consumers reported difficulty understanding pharmacy quality measures because of knowledge deficits.¹⁵ If patients are not accustomed to using quality information or knowledgeable of the meaning of quality reports, they might not be able to use such information. Quality reports should include useful educational information¹² and be widely disseminated to all patient groups. If quality measures information is comprehensible, the provider selection decision-making process will be easier and more effective for patients.

The majority wanted pharmacy reports formatted to display an overall pharmacy rating for quick access and then condition-specific ratings for detail. Comparative data on the performance of physician groups in the US showed that the presentation of summary measures of provider quality and the ability to assess further details if needed was important to patients.^20,25 In this current study, participants did not favor the "lower is better´ format for presenting quality ratings due to previous experiences with higher numbers meaning better performance. Similarly, Massachusetts primary care physician groups structured their quality measures with a "higher being better´ framework.²² Using a "higher is better´ frame to present quality information is consistent with how individuals think about and process numbers.²⁰ Simple changes in information presentation that meets the cognitive expectations of consumers is key to increased comprehension of comparative quality information. In addition, a better formatting of pharmacy performance data will enable community pharmacies to appropriately compare their performance to other pharmacies within their communities or state.

Consumers preferred the use of a star rating system compared to the use of other methods for displaying quality ratings including percentages, letter grades, and numerical values, due to the visual nature of the star system. Familiarity with previous approaches of rating other performance information (the use of stars) possibly made participants more comfortable with the star rating system. Previous research has shown that consumers rarely use public reports of healthcare quality due to their poor design and formats, rather than a lack of interest in the information.^12,23-26 To achieve optimal use of report cards, desired formats and designs of pharmacy quality reports which will meet the needs of pharmacy-users´ should be further explored.

This study showed that pharmacy users are interested in pharmacy quality information, would inquire about quality ratings from their pharmacies, and would seek quality information if educated on the content. Previous studies confirm that consumers are highly interested in quality-of-care information.^4,27,28 In two studies, almost half of the consumers stated that having high quality care was the most important concern they face when choosing a health provider.^4,29 Publicly reported quality information is intended to stimulate active consumer participation in provider selection and increase transparency.¹⁵ Patient interest in pharmacy quality information is a positive motivation towards developing publicly available quality reports.

Besides the inclusion of quality measures information in public reports, consumers wanted other pharmacy information such as service information, patient satisfaction results and cost of medications included. Our previous pilot work among lay consumers showed that cost of medications and the relationship with the pharmacist were factors favored over the use of quality measures data in choosing a pharmacy.¹⁶ In other studies, service-based factors, price and the type of services being offered at a pharmacy have been shown to be important in pharmacy choice. Patients like to use satisfaction measures in decision-making, especially if the responses are from people like themselves who are making similar choices.³⁰

Consumers wanted access to pharmacy quality information through various dissemination avenues, including the internet, doctors´ offices and pharmacies. The wide dissemination of public reported pharmacy quality information is important in the education of consumers about pharmacy quality. These findings provide some direction to the appropriate placement of pharmacy quality information for consumers, when available.

Some consumers did not think that the quality measures presented were the most appropriate measures for rating pharmacies. Previous research has shown that consumers rarely use public reports of healthcare quality due to the irrelevant content contained within the report cards.^12,23,25 For public reporting of pharmacy quality information to be effective, reports need to provide patients with consumer-relevant information that can help inform their conversations with their pharmacists and help guide their health care decisions.

The study findings had key implications for community pharmacies and pharmacy management organizations. For example, an in-depth understanding and meaningful interpretation of pharmacy performance data will allow community pharmacists to demonstrate the impact their care has on patient outcomes. This information is especially useful to payers who might assess pharmacies for pay-for-performance metrics. If community pharmacies understand how pharmacy quality data is being formatted and used in evaluations, they will know how their pharmacy is being measured and evaluated compared to state and national performance data, they will be able to assess where they are having the best impact in the quality of patient care, and then they will be able to identify opportunities to improve the care delivered to patients.¹¹

This study had some limitations. The study sample was small, predominantly English-speaking white females and located in one state which limits the ability to generalize the study findings to other racial/ethnic groups and settings. However, the study sample somewhat represents the residents within the study´s geographic location.³¹ The use of a qualitative study design also limits the ability to make generalized concluding statements. Participants´ self-reported their diagnosis of a chronic illness and this was not confirmed by medical records. Inter-rater reliability between the individuals who coded the data was not determined by statistical analysis but by consensus. Finally, the survey questions were not pretested or pilot-tested before its use in the study.

 

Conclusions

Individuals who have a chronic illness and regularly use community pharmacies are interested in pharmacy quality measures. However, quality measures need to be understood by patients. Simple and plain language with data formats and presentations that meet the cognitive expectations of consumers is the best approach to communicating quality information. If patients are accustomed to using quality information or knowledgeable of the meaning of quality reports, they might be able to use such information. This study´s participants had specific preferences for the display and format of pharmacy quality information which will be helpful in the design of appropriate quality report systems.

 

Acknowledgement

The authors would like to acknowledge Trent Harris and Alicia Christensen who helped with the data collection and coding of the focus group transcripts. Also, we thank David Nau, President of Pharmacy Quality Solutions (Senior Director for Quality Strategies, PQA at the time of the study) for providing advice and direction for this study.

 

Conflict of interest

The authors have no conflict of interest.

The sponsor had no role in the study design, data collection and analysis, the interpretation of the data, and in the decision to submit the paper for publication.

 

References

1. Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA. 2000;283(14):1866-1874.         [ Links ]

2. Mukamel DB, Mushlin AI, Weimer D, Zwanziger J, Partker T, Indirdason I. Do quality report cards play a role in HMO´s contracting practices? Evidence from the New York State. Health Serv Res. 2000;35(1 Pt 2):319-332.         [ Links ]

3. Robinowitz DL, Dudley RA. Public reporting of provider performance: can its impact be made greater. Annu Rev Public Health. 2006;27:517-536.         [ Links ]

4. Hibbard JH, Stockard J, Tusler M. Hospital performance reports: impact on quality, market share, and reputation. Health Aff (Millwood). 2005;24(4):1150-1160.         [ Links ]

5. Lansky D. Improving quality through public disclosure of performance information. Health Aff (Millwood). 2002;21(4):52-62.         [ Links ]

6. Marshall MN, Shekelle PG, Davies HT, Smith PC. Public reporting on quality in the United States and the United Kingdom. Health Aff (Millwood). 2003;22(3):134-148.         [ Links ]

7. Marshall M, Davies H. Public release of information on quality of care: how are health services and the public expected to respond? J Health Serv Res Policy. 2001;6(3):158-162.         [ Links ]

8. Schenider EC, Lieberman T. Publicly disclosed information about the quality of healthcare: response of the US public. Qual Health Care. 2001;10(2):96-103.         [ Links ]

9. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6 Pt 1):1918-1930.         [ Links ]

10. Pharmacy Quality Alliance. PQA endorsed set of measures. Available at http://pqaalliance.org/measures/default.asp.pdf (accessed February 5, 2014).         [ Links ]

11. Nau DP. Measuring pharmacy quality. J Am Pharm Assoc (2003). 2009;49(2):154-63. doi: 10.1331/JAPhA.2009.09019.         [ Links ]

12. Hibbard JH, Slovic P, Peters E, Finucane ML. Strategies for reporting health plan performance information to consumers: evidence from controlled studies Health Serv Res. 2002;37(2):291-313.         [ Links ]

13. Marshall MN, Romano PS, Davies HT. How do we maximize the impact of the public reporting of quality of care? Int J Qual Health Care. 2004;16(Suppl 1):i57-i63.         [ Links ]

14. Hibbard JH, Berkman N, McCormack LA, Jael E. The impact of a CAHPS report on employee knowledge, beliefs, and decisions. Med Care Res Rev. 2002;59(1):104-116.         [ Links ]

15. Faber M, Bosch M, Wollersheim H, Leatherman S, Grol R. Public reporting in healthcare: how do consumers use quality of care information? A systematic review. Med Care. 2009;47(1):1-8. doi: 10.1097/MLR.0b013e3181808bb5.         [ Links ]

16. Shiyanbola OO, Mort JR, Lyons K. Advancing the utility of community pharmacy quality measures: a qualitative study. J Am Pharm Assoc (2003). 2013;53(4):400-407. doi: 10.1331/JAPhA.2013.12160.         [ Links ]

17. Huston SA, Hobson EH. Using focus groups to inform pharmacy research. Res Social Adm Pharm. 2008;4(3):186-205. doi: 10.1016/j.sapharm.2007.09.001.         [ Links ]

18. Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5:1-11.         [ Links ]

19. The public health researcher: A methodological approach. Melbourne: Oxford University Press, 1997.         [ Links ]

20. Peters E, Dieckmann N, Dixon A, Hibbard JH, Mertz CK. Less is more in presenting quality information to consumers. Med Care Res Rev. 2007;64(2):169-190.         [ Links ]

21. Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports that clearly communicate to consumers the meaning of quality of care. Med Care Res Rev. 2010;67(3):275-293. doi: 10.1177/1077558709356300.         [ Links ]

22. Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293(10):1239-1244.         [ Links ]

23. Kaiser Family Foundation. 2008 update of consumers´ views on patient safety and quality Menlo Park, CA. Available at http://www.kff.org/kaiserpolls/posr101508pkg.cfm (accessed August 13, 2014).         [ Links ]

24. Kaiser Family Foundation, a national survey on consumers experiences with patient safety and quality information. Available at http://www.kff.org/kaiserpolls/7209.cfm (accessed August 13, 2014).         [ Links ]

25. Building the Science of Public Reporting, Research Grants. Available at http://www.ahrq.gov/legacy/qual/value/sciencepubreport.htm (accessed August 13, 2014).         [ Links ]

26. Massachusetts Health Quality Partners. Available at www.mhpq.org (accessed August 13, 2014).         [ Links ]

27. Longo DR, Everet KD. Health care consumer reports: an evaluation of consumer perspectives. J Health Care Finance. 2003;30(1):65-71.         [ Links ]

28. Boscarino JA, Adams RE. Public perceptions of quality care and provider profiling in New York: implications for improving quality care and public health. J Public Health Manag Pract. 2004;10(3):241-250.         [ Links ]

29. Robinson S, Brodie M. Understanding the quality challenge for health consumers: the Kaiser/AHCPR Survey. Jt Comm J Qual Improv. 1997;23(5):239-244.         [ Links ]

30. Arnold SD. Improving quality health care: the role of consumer engagement. Robert Wood Johnson Foundation Issue Brief. Page 1-6. Available at http://www.academyhealth.org/files/issues/ConsumerEngagement.pdf (accessed February 7, 2014).         [ Links ]

31. Caiaazza A, Shaw A. The Status of Women in South Dakota. Institute for Women´s Policy Research. Washington DC, October 2004.         [ Links ]

 

 

Received (first version): 29-May-2014
Accepted: 6-Oct-2014