Author(s)
Jay Duhig, MA, Doctoral Student1, Marcia Edison, PhD, Research Assistant Professor1, William Galanter, MD, PhD, Medical Director Clinical Information Systems1, Michael Koronkowski, PharmD, Clinical Assistant Professor1, Bruce L Lambert, PhD, Director, UIC TOP-MED CERT1, Amy Lodolce, PharmD, Clinical Assistant Professor1, A. Simon Pickard, PhD, Associate Professor2, Caitlyn T. Wilke, MS, Doctoral Candidate1, Gordon Schiff, MD, Associate Director, Center for Patient Safety Research and Practice31University of Illinois at Chicago, Chicago, IL, USA; 2 College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 3 Brigham and Women's Hospital, Boston, MA, USA
OBJECTIVES: Hospital formularies are variously viewed as tools for enhancing patient safety by promoting more rational prescribing to obtrusive cost barriers that negatively affect patient care. The objective of this study was to describe the development of a measure for assessing clinical practitioners' knowledge, attitudes and behaviors with respect to the formulary process and committee. METHODS: The Formulary Culture Survey (FCS) was modeled on the established literature of patient safety culture measurement. Focus group interviews of formulary committee members identified specific themes for item development within five conceptualized domains: (1) Global Trust, Confidence and Credibility, (2) Structure and Process of Formulary Committee, (3) Dimensions of Formulary Performance, (4) General Attitudes, (5) Familiarity of Drug Information Resources. Items were pilot tested in a 50 question online survey. These items were then categorized according to expert judgment into 14 domains. Refinement to the FCS was guided by factor analysis and Rasch models. RESULTS: Attending and resident physicians from a university (n= 54) and county hospital (n=135) completed the initial survey. The 50 items indicated 14 separate underlying constructs. Exploratory factor analysis supported 4 domains that accounted for 39% of the variance in the responses: Physician Attitudes Towards Formulary (General), Trust in Formulary Committee Decisions, Beliefs About Formulary Approval Process and Physician Attitudes Towards Pharmaceutical Industry Influence. Based on Rasch and factor analysis, 12 items were identified for modification in future versions. CONCLUSION: Preliminary evidence supports the conceptual basis for a tool to measure formulary culture. The identification, operationalization and validation of the constructs that comprise the knowledge, attitudes and behaviors of clinical practitioners with respect to drug formularies may provide insight into the perceived role of formularies in promoting good clinical outcomes. Future research involves a larger scale validation study.
Conference/Value in Health Info
2009-05, ISPOR 2009, Orlando, FL, USA
Value in Health, Vol. 12, No. 3 (May 2009)
Code
FD3
Topic
Methodological & Statistical Research
Topic Subcategory
Modeling and simulation
Disease
Multiple Diseases
