Background

Implementation outcomes serve as progress and success indicators of the implementation process. They are also key antecedents to achieving the more traditional clinical outcomes typically associated with a service. Despite their importance, there are few implementation outcomes measures with appropriate psychometric properties, none of which have yet been adapted for medication optimization services.

Objectives

This study aims to develop and validate the Implementation Outcomes Questionnaire (IOQ) to assess implementation of medication optimization services, starting with Comprehensive Medication Management (CMM). The resulting IOQ is a 40-item self-report instrument for six implementation outcomes, including adoption, acceptability, feasibility, appropriateness, penetration, and sustainability.

Methods

A three-phase approach was used to develop and validate the IOQ. Development of the instrument, Phase I, was informed by a targeted search of existing implementation outcomes measures in other fields, a review of suitableoptions options by an expert panel, and item adaptation. To assess content validity, Phase II, an internal vetting process was conducted using an adapted version of Rubio and colleagues’ methodology. Evidence of reliability and construct validity, Phase III, was obtained through a pilot test with 167 pharmacists within 78 different care settings.

Results

Overall, the results supported the reliability and validity (both content and construct) of the IOQ, with further psychometric testing needed for adoption. The items' relevance, clarity, and alignment with each implementation concept were high, except for Penetration. As a result, the Penetration items were refined for further use. Best-fit models were identified for each outcome based on the MCFA analyses, thereby providing insights into the factor structures and interpretation for each measure. Cronbach’ alphas indicated good internal consistency.

Conclusions

This questionnaire is the first of its kind tailored to medication optimization services, starting with CMM. Access to this survey should facilitate measurement of implementation outcomes, thereby increasing the likelihood of achieving the desired clinical outcomes.

中文翻译：

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衡量药物优化服务的实施：开发和验证实施结果问卷

背景

实施结果作为实施过程的进展和成功指标。它们也是实现通常与服务相关的更传统临床结果的关键前提。尽管它们很重要，但很少有具有适当心理测量特性的实施结果措施，这些措施都尚未适用于药物优化服务。

目标

本研究旨在制定和验证实施结果问卷 (IOQ)，以评估药物优化服务的实施，从综合药物管理 (CMM) 开始。由此产生的 IOQ 是一个包含 40 个项目的自我报告工具，用于六个实施结果，包括采用、可接受性、可行性、适当性、渗透性和可持续性。

方法

使用三阶段方法来开发和验证 IOQ。第一阶段工具的开发通过对其他领域现有实施结果措施的有针对性搜索、专家小组对合适选项选项的审查以及项目改编提供了信息。为了评估第二阶段的内容有效性，内部审查过程使用卢比奥及其同事的方法的改编版本进行。第三阶段的可靠性和结构有效性的证据是通过对 78 个不同护理环境中的 167 名药剂师进行的试点测试获得的。

结果

总体而言，结果支持 IOQ 的可靠性和有效性（包括内容和结构），需要进一步的心理测试才能采用。除了渗透率之外，这些项目的相关性、清晰度和与每个实施概念的一致性都很高。结果，渗透项目被改进以供进一步使用。基于 MCFA 分析为每个结果确定了最佳拟合模型，从而提供对每个度量的因子结构和解释的见解。Cronbach' alphas 表明良好的内部一致性。

结论

该问卷是同类药物优化服务中的第一个，从 CMM 开始。访问此调查应有助于衡量实施结果，从而增加实现预期临床结果的可能性。