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Activity 12: Pharmacy Assessment Tour

Topic: Assessing the Health Literacy Practices of Pharmacies

Use in:

• Experiential education (APPE).
• Project (PharmD or residency project).

Time Commitment Estimate: 4 hours (experiential education); minimum of 8 hours (project)

Learning Objectives:

• Describe the ways in which the layout and interactions between staff and patients at a pharmacy can affect a patient's experience.
• Demonstrate how to assess the layout and staff-patient interactions at a pharmacy and identify areas for improvement.
• Demonstrate synthesizing and presenting assessment findings to pharmacy management.
• Activity Description: Ideally with a colleague or another student, use AHRQ's Pharmacy Health Literacy Assessment Tool User's Guide, Part I: Assessment Tour of the Pharmacy, to assess the physical environment and staff interactions with patients at a pharmacy (e.g., your rotation sites). Thoroughly read the assessment tour instructions (Part I) and discuss any questions with your colleague. Revise the assessment tools as necessary for the environment in which it is being used. Then, each team member should conduct the assessment of the pharmacy independently to minimize bias. As you complete the assessment, do not be afraid to be critical. The purpose of the assessment is to increase awareness and spur discussion and change among pharmacy leadership. Once each team member has completed the assessment, follow the instructions in the User's Guide to analyze your results. Discuss each team member's results. Write a report that describes how you assessed the pharmacy, your findings (quantitative and qualitative), and recommendations for how to change the pharmacy set-up or expectations of staff to better serve patients of all health literacy levels. Include a summary of your findings that could be presented to pharmacy management. If you assessed your APPE site or residency site, present the results and full report to your preceptor, pharmacy staff, and management.

Evaluation Criteria: Students/residents should demonstrate that they completed the assessment following the Guide. Reports should present a holistic picture of assessment results and include quantitative (i.e., assessment scores) and qualitative (i.e., reasons for low or high scores) information, as well as thoughtful recommendations. The executive summary should be succinct and relevant to management.

Relevant PowerPoint® Slides:

• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part I.
• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part II.

Resources:

• Jacobson K, Gazmararian J, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide. (Prepared under contract No. 290-00-0011 TO7.) ´óÏóÊÓƵPublication No. 07-0051. Rockville, MD: ´óÏóÊÓƵ. October 2007. Part I: Assessment Tour of the Pharmacy.

Activity 13: Surveying Pharmacy Staff to Assess a Pharmacy

Topic: Assessing the Health Literacy Practices of Pharmacies

Use in:

• Experiential education (APPE).
• Project (PharmD or residency).

Time Commitment Estimate: 4-8 hours (experiential education); minimum of 12 hours (project)

Learning Objectives:

• Explain the importance of staff perspective and experiences in assessing a pharmacy's practices.
• Conduct a survey of pharmacy staff to assess a pharmacy.
• Interpret survey results and recommend changes to pharmacy management.

Description: Use AHRQ's Pharmacy Health Literacy Assessment Tool User's Guide to complete a Survey of Pharmacy Staff. Revise the instrument as necessary to meet the needs of the environment being assessed. Follow the instructions in the User's Guide to administer the survey; you might consider creating an electronic version of the survey using a commercial survey program. After the staff have completed the survey, code and analyze your results per the User's Guide instructions. Write a report of your findings, including recommendations for how to change the pharmacy set-up or expectations of staff to better serve patients of all health literacy levels. The report should include an introduction that discusses the problem of health literacy and why you conducted the survey; a methods section that describes the survey, how you administered and analyzed it and how many staff participated; a summary of the results; results providing a summary of the results; and a discussion of what the findings mean, what solutions or changes you would recommend, etc.

Project: In addition to the activity above, also include a summary of your findings to present to pharmacy staff and management. Then present the study results to pharmacy staff. Following the presentation, ask pharmacy staff and/or management what was surprising about your results. Write a short reflection on your experiences with this project to include at the end of your paper a write-up answering questions such as:

• What did you learn about the pharmacy?
• What was surprising about the results (for you and for pharmacy staff/management)?
• How can the results be used to improve patient care?

Some helpful tips you may want to consider before distributing the survey:

• Staff are more likely to complete the survey if you provide incentives—paid staff time (with management approval), food, or monetary incentives may help.
• Providing staff context for the survey (i.e., explaining why it's important for them to complete it) and firm deadlines may also help increase response rates. Guarantee anonymity to promote candor.
• Depending on your university, you may need Institutional Review Board (IRB) approval to conduct this survey. Always check with your IRB before conducting research with any human subjects.

Evaluation Criteria: Successful assessments will closely follow instructions described in the ´óÏóÊÓƵUser's Guide. Reports will present a holistic picture of assessment results and will include quantitative (i.e., assessment scores) and qualitative (i.e., reasons for low or high scores) information in addition to a thoughtful discussion with recommendations for improvement. The summary should be succinct and relevant to pharmacy management. Students/residents' reflection should demonstrate thoughtful engagement with the topic and consideration of the reflection questions posed above.

Relevant PowerPoint® Slides:

• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part I.
• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part II.

Resources:

• Jacobson K, Gazmararian J, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide. (Prepared under contract No. 290-00-0011 TO7.) ´óÏóÊÓƵPublication No. 07-0051. Rockville, MD: ´óÏóÊÓƵ. October 2007. .

Activity 14: Using Patient Feedback for Quality Improvement

Topic: Assessing the Health Literacy Practices of Pharmacies

Use in:

• Experiential education (APPE).
• Project (PharmD or residency project).

Time Commitment Estimate: minimum of 20 hours (APPE or project)

Learning Objectives:

• Explain the importance of patient perspectives and experiences in assessing a pharmacy's health literacy practices.
• Design and execute a focus group, survey, or interviews of patients to assess a pharmacy.
• Interpret focus group, survey, or interview results and recommend changes to pharmacy leadership.
• Recommend areas to improve health literacy practices of a pharmacy.

Activity Description: Use AHRQ's Pharmacy Health Literacy Assessment Tool User's Guide to complete a Pharmacy Patient Focus Group or patient surveys or interviews. You may want to consider conducting interviews instead of a focus group if logistical factors would make a focus group difficult at your pharmacy (e.g., space). Use the questions provided in the User's Guide for the patient focus group, and adapt if needed to an interview or survey format. Once you have completed the focus group, surveys, or interviews, follow the instructions in the User's Guide to analyze your results.

Write a complete report. The report should include an introduction that discusses the problem of health literacy and why you did the survey; a methods section that describes the survey, how you administered and analyzed it, and how many staff participated; a summary of the results; and a discussion of what the findings mean, what solutions or changes you would recommend, etc. Also include a summary of your findings to present to pharmacy staff and management. Then present the study results to pharmacy staff. Once you have presented your findings to the pharmacy staff, write a short reflection on your experiences with this project to include at the end of your report, answering questions such as:

• What did you learn about the pharmacy?
• What was surprising about the results?
• How can the results be used to improve patient care?

Helpful Tips: Some helpful tips you may want to consider before conducting patient focus groups, surveys, or interviews (go to Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide— for additional tips):

• Consult with your university's IRB to determine whether or not you need approval for your research. (You should always do this before conducting research with patients).
• Even if IRB approval is not required, you should obtain consent from all participants.
• If you conduct a focus group, expect people not to show and provide incentives (such as snacks and/or gift certificates) to encourage patients to attend.
• If you conduct a focus group, make sure you have a separate moderator and note-taker. If possible, audiotape focus groups so you can refer back to recordings if necessary.
• If you conduct a focus group, recruit 1.5 times as many patients as you would like to participate for the focus group; you can generally assume that several participants will not show up.
• Consider a variety of recruitment strategies (flyers, phone invitations, etc.).
• Prior to recruitment, you may want to identify eligibility criteria for participants. For example, should all participants have low health literacy? Do you want participants with or without chronic diseases? Do you want a certain age range? Track information like this so that you can report it in your results.

Faculty Note: This activity may be broken into two phases with faculty feedback provided at the end of each phase: (1) development of data collection plan, including modification of focus group moderator's guide (if applicable), and (2) analysis of results and summary of findings.

Evaluation Criteria: Students should demonstrate they used the User's Guide, and thoughtfully adapted it to their pharmacy's context and needs. Reports should include reflection on the data collection process as well as analysis and synthesis of results and recommendations for improvement. The summary should be succinct and relevant to pharmacy management. Students' reflection should demonstrate thoughtful engagement with the topic and consideration of the reflection questions posed above.

Relevant PowerPoint® Slides:

• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part I.
• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part II.

Resources:

• Jacobson K, Gazmararian J, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide. (Prepared under contract No. 290-00-0011 TO7.) ´óÏóÊÓƵPublication No. 07-0051. Rockville, MD: ´óÏóÊÓƵ. October 2007. .
• ´óÏóÊÓƵFocus Group Guide (Available in English and Spanish)Jacobson K, Gazmararian J, Kripalani S, McMorris K, Blake S, Brach C. ´óÏóÊÓƵ. Available at: http://www.ahrq.gov/health-literacy/improve/pharmacy/guide/app-5.html (English); http://www.ahrq.gov/health-literacy/improve/pharmacy/sp-facilitator-guide.html (Spanish).
• Krueger RA, Casey MA. (2000). Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA: SAGE Publications.

Activity 15: Reporting on Survey Assessment Results

Topic: Assessing the Health Literacy Practices of Pharmacies

Use in:

• Didactic (assignment).
• Experiential education (IPPE).

Time Commitment Estimate: 2–4 hours

Learning Objectives:

• Demonstrate how to analyze and interpret assessment results for meaningful conclusions, including recommendations for how to change future practice

Activity Description: Acadia Pharmacy, a large retail pharmacy assessed their pharmacy's health literacy practices using the pharmacy staff survey from the Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide. Exhibit 1 presents the results for the pharmacy staff survey of 16 staff members. Using the Assessment Tool guidance on how to analyze the survey data and write-up results, develop a report on the main findings from the survey results (e.g., what is the pharmacy doing well, what is it not doing well, etc.) below, and provide recommendations to potentially improve Acadia Pharmacy's health literacy practices. Provide a summary of findings, several main takeaways and recommendations for each of the areas covered: 1) print materials 2) verbal communication and 3) sensitivity to literacy. In Exhibit 1 the numbers correspond to the following on the survey:

1. This is something the pharmacy is not doing.
2. Our pharmacy is doing this but could make some improvements.
3. Our pharmacy is doing this well.

Evaluation Criteria: Students will demonstrate in their reports that they thoroughly and accurately summarized the findings of the pharmacy staff survey, and provided appropriate recommendations.

Relevant PowerPoint® Slides:

• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part I.
• Advancing Health Literacy Practices in Pharmacy through Quality Improvement—Part II.

Resources:

• Jacobson K, Gazmararian J, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide. (Prepared under contract No. 290-00-0011 TO7.) ´óÏóÊÓƵPublication No. 07-0051. Rockville, MD: ´óÏóÊÓƵ. October 2007.

Go to Activity Guides 1-7.
Go to Activity Guides 8-11.
Go to Activity Guides 16-17.