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The Asthma Quality of Life Questionnaire for Native American Adults (AQLQ-NAA) was developed by modifying the Asthma Quality of Life Questionnaire-Marks (AQLQ-M) using the focus group technique. The 19-item AQLQ-NAA has emphasis on restrictions in social, community, and cultural activities. Higher scores indicate a better quality of life. The modified questionnaire was administered to a sample of 51 Native American adults with asthma at the Albuquerque USPHS Indian Hospital and its affiliated field clinics. Principal components analysis identified three domains with eigenvalues greater than 1.00: Community and Social Restrictions (CSR), Psychological Impact (PIM), and Symptoms (SYM). Cronbach's coefficient alpha for the AQLQ-NAA was 0.95 and ranged from 0.82 to 0.93 for the individual domains, indicating good internal consistency. The AQLQ-NAA score correlated negatively and significantly to urgent care visits, physician visits, and total number of medications taken for asthma in the past 6 and 12 months (p < 0.05). Additionally, the AQLQ-NAA score was correlated positively and significantly to medication adherence in the past 6 and 12 months (p < 0.05). Similar patterns of correlations were found with all three domain scores. These results indicated that there is evidence for the construct validity of the AQLQ-NAA and its domains. The AQLQ-NAA should provide a useful measure of HRQOL in asthma-specific medical interventions for the population in which it was developed.

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OBJECTIVE: Physicians have been surveyed concerning their satisfaction with poison center services but have never been questioned regarding their expectations. This study was conducted to clarify the expectations of emergency physicians in New Mexico regarding the service of their regional poison center, the New Mexico Poison and Drug Information Center. DESIGN: Five New Mexico emergency department physicians were interviewed about their expectations when calling the New Mexico Poison and Drug Information Center. Their responses were combined with unique, additional expectations identified by the New Mexico Poison and Drug Information Center staff in order to develop a 62-item physician expectation mail survey instrument. Respondents were asked to rank the importance of each service expectation on a 5-point Likert scale (1 = not important, 5 = extremely important). RESULTS: A usable return rate of 60% was achieved (104 surveys). Fifty-eight (94%) expectations had a mean importance rating of > or = 3 (important). Ninety-four percent of the expectations included on the survey were being provided by the New Mexico Poison and Drug Information Center. CONCLUSION: Currently, there is a good fit between New Mexico emergency physician expectations and New Mexico Poison and Drug Information Center services provided. The instrument identified several areas where service was expected but not provided (Internet access to poison center, provision of industrial/occupational toxicology services, provision of tele-medicine capability) and where service was provided but not expected (drug dosing information). Surveying can be a valuable tool for clarifying expectations for poison center services.

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A method of evaluating health-related quality-of-life (HRQL) instruments is described. Selection of an HRQL instrument should be based on the intended purpose and how well the instrument satisfies that purpose. An available methodological framework for developing HRQL instruments can be used; its premise is that the developmental process and psychometric properties of an instrument vary with the intended purpose. Intended purposes are classified as evaluative, discriminative, and predictive. Developmental steps are selection of items, item scaling, item reduction and assessment of internal consistency, and determination of reliability, validity, and responsiveness. Specific criteria apply to each step. An evaluation of asthma-specific HRQL instruments demonstrates use of the method. A useful method exists for selecting among available HRQL instruments on the basis of the instruments' intended purposes.

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OBJECTIVE: To review and evaluate research on pharmaceutical services in community and ambulatory care pharmacy settings, specifically study designs and patient outcome measures, and to provide recommendations to improve future research on pharmaceutical services in community and ambulatory care pharmacy settings. DATA SOURCE: English-language articles were identified by searching MEDLINE (1966-December 1998) and International Pharmaceutical Abstracts (1970-December 1998), using a combination of search terms: pharmacist services, pharmacist interventions, community pharmacy, ambulatory care, primary care, and patient outcomes. Relevant studies were selected based on article abstracts. DATA EXTRACTION: From each relevant study, we extracted the study objectives, sample size, study period, study design, major tasks performed by pharmacists, and economic, clinical, and humanistic outcomes (ECHO). Results were tabulated separately for research on community pharmacy and ambulatory care pharmacy settings. RESULTS: We identified 95 relevant studies. Of these, 21 studies were conducted in community pharmacy settings and 74 in ambulatory care settings. Ten community pharmacy studies used prospective, single group, pretest/posttest, or posttest only designs; seven used prospective two or more group comparison designs; and four used randomized, controlled designs. Nine studies on community pharmacies measured clinical outcomes, two measured humanistic outcomes, and five measured economic outcomes. Four studies measured both clinical and humanistic outcomes and one measured humanistic and economic outcomes. No study measured all three ECHO variables. Twenty-three studies in ambulatory care settings used prospective or retrospective, single group, pretest/posttest or posttest only designs; 21 used prospective or retrospective two-or-more group comparison designs; and 30 used randomized, controlled designs. Thirty-six measured clinical outcomes, five measured humanistic outcomes, and 15 measured economic outcomes. Fifteen studies measured clinical and economic outcomes and three measured clinical and humanistic outcomes. CONCLUSIONS: Only 21 of 95 selected studies were conducted in community pharmacy settings and measured the impact of pharmaceutical services on patient outcomes. Few studies employed adequate research designs to control threats to internal and external validity. In order to obtain a comprehensive and accurate picture of the impact of pharmaceutical services on patient outcomes, an attempt must be made to measure all three ECHO variables while employing adequate research design.

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Items in Spector's Work Locus of Control-Scale were modified to reflect how much control the respondent feels he might have on a job as opposed to what he feels people in general have. This modified Work Locus of Control Scale was tested for reliability and construct validity. As part of a larger study, data were collected via mail questionnaires from a sample of 284 pharmacists licensed in Indiana. The Cronbach coefficient alpha for the modified scale was .88, indicating good internal consistency. The modified scale also showed some evidence of convergent validity when correlated with scores on measures of Extraversion, Conscientiousness, Neuroticism, and Job Dissatisfaction.

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To render quality-of-life scores on an instrument acceptable for cross-national comparison, the instrument's reliability and validity must be established in all countries in question. The Asthma Quality of Life Questionnaire-Marks (AQLQ-M) was developed in Australia, where it was shown to have good reliability and validity. However, no attempt had been made to determine the psychometric properties of the AQLQ-M and its domains (i.e., Breathlessness, Mood, Social, and Concerns) in the United States. The objectives of the present study were to administer the AQLQ-M to a sample of adult asthmatic patients in the United States (N = 106) and assess (1) the acceptability of the AQLQ-M to respondents, (2) the internal consistency of the AQLQ-M and its domains, and (3) the construct validity of the AQLQ-M and its domains. Results indicated that respondents did not have difficulty answering the questions in the AQLQ-M. The Cronbach coefficient alpha value for the AQLQ-M was 0.94. The Cronbach coefficient alpha value for individual domains ranged from 0.84 to 0.91, providing evidence of good internal consistency reliability for the AQLQ-M and its domains. Pearson product-moment correlations between the domain scores ranged from 0.62 to 0.88, indicating that the domains were related but separate aspects of asthma-specific quality of life, as measured by the AQLQ-M. Spearman rank-order correlations of the AQLQ-M score and domain scores with an indicator of disease severity--number of different prescription medications taken for asthma in the preceding 3 months-were positive and significant. This indicated that subjects taking a greater number of prescription asthma medications had higher AQLQ-M and domain scores, or a greater negative impact of asthma on quality of life, a result consistent with previous findings and one that provides some evidence of convergent validity. Our findings support the use of the AQLQ-M as a decision-making tool in the United States and in cross-national comparisons between the United States and Australia.

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OBJECTIVE: To develop and test a questionnaire that can be used to measure directive guidance behaviors by pharmacists. QUESTIONNAIRE DESIGN: The Purdue Pharmacist Directive Guidance (PPDG) scale was developed based on the directive guidance dimension of socially supportive behaviors, as described by Barrera and Ainlay. The final scale consists of 10 items. SUBJECTS: Individuals on the Walker Test Crew database who were 18 years of age or older and self-reported taking medications for asthma, hypertension, and/or diabetes in the past 3 months were eligible for inclusion. All data were collected through telephone interviews. A total of 464 contacts were made, resulting in 300 responses. DATA ANALYSIS: Principal components analysis was performed to determine the construct subscales of the PPDG. Internal consistency of the PPDG and its subscales was assessed using Cronbach's alpha and corrected item-total correlations. Pearson product-moment correlations of the PPDG with measures of family and friend support (FFS) and self-reported medication adherence were used to determine convergent validity. Spearman rank-order correlations of the PPDG with the total number of prescription medications as well as those for asthma, hypertension, and diabetes taken in the past 3 months were obtained. ANOVA and Student's t-tests were used to determine differences in PPDG across demographic characteristics. RESULTS: Principal components analysis yielded two subscales for the PPDG. These were named Instruction and Feedback and Goal Setting, based on their content. The PPDG scale had good internal consistency (Cronbach's alpha = 0.86), and correlated positively and significantly with FFS (r = 0.27), giving some evidence of convergent validity. The PPDG scale and its subscales also had logically intuitive positive and significant correlations with the total number of prescription drugs taken in the past 3 months. CONCLUSIONS: The PPDG is short and easy to administer, and showed validity and reliability. The PPDG scale should be useful in developing a better understanding of the process by which pharmacists influence healthcare outcomes, assessing variations in pharmaceutical care, and as a tool in identifying means of overcoming barriers to higher levels of pharmaceutical care.

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Scores from a sample of pharmacists on the Health Professions Stress Inventory were factor analyzed to identify any underlying components of these professionals' job-related stress. Data were collected via mail questionnaires from a nationwide sample of 573 practicing pharmacists. Three- and four-factor solutions, using both orthogonal and oblique rotations, were compared. Based on these comparisons, a four-factor oblique solution was judged to be most appropriate, the four factors being labeled Professional Recognition, Patient Care Responsibilities, Job Conflicts, and Professional Uncertainty. The factors show evidence of internal consistency and construct validity.

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This study compared the factor structure and burnout scores obtained on the Maslach Burnout Inventory from 84 pharmacists in Health Maintenance Organizations (HMO) with the normative data for USA pharmacists. Results provided empirical support for the reliability and validity of the inventory to measure burnout within the profession of pharmacy. Values of Cronbach coefficient alpha for subscales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment were similar to those obtained with the normative sample. Factor analysis was conducted to yield the best three-factor solution. Derived factor loadings matched the three hypothesized subscales. On Personal Accomplishment the mean subscale score for HMO pharmacists was significantly higher than the normative score. Given limitations of the small sample, research is indicated to substantiate use of the inventory among HMO pharmacists.

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