Study design and setting
A mixed-method study was conducted to develop and validate the pharmacist care model and definition, including an extensive literature review, experts’ opinions and the Delphi method.
Phase I. pharmacist care model development and validation
Literature review
An extensive literature review for more than three years was done during editing the book entitled: “Handbook of Evidence-Based Pharmacist Care: Clinical, Economical and Humanistic Impact with Practical Guide and Case Studies Around the World” “an un-published handbook for publication, which includes the evidence-based clinical, economics and humanistic impact of pharmacist care on all diseases/conditions such as (Cardiovascular disorders; pulmonary disorders; renal disorders; gastrointestinal disorders and others); Services such as (Therapeutic Drug Monitoring (TDM); Enteral and Parenteral Nutrition, Vaccination, Medication Safety; Smoking Cessation; Weight Management; Health Promotion; Medication Therapy Management and others), all previous definitions, pharmaceutical care models, books and literatures [1-5] and other literature about the pharmaceutical care. The study was conducted in line with Good Clinical Practice guidelines and in line with the DELPHISTAR – Delphi studies in social and health sciences – recommendations for a standardized reporting (2022)[6] (See appendix 1)” See the study flowchart (Figure 1). The initial draft of the model and one definition were developed in this step; model themes are presented in (figure 2 and table 1).
Please insert figure 1 here
Experts’ selection
Experts’ panel selection was based on any one of the following: registered pharmacists with at least five years of experience in pharmacy practice; or lecturers in pharmacy practice with at least five years of experience in teaching pharmacy practice courses, clinical pharmacy courses, social pharmacy courses or any discipline related to patient care; have/had to experience in the United States or Canada or the United Kingdom or Australia hospitals, pharmacies or health care systems and hospital pharmacists in hospitals provided clinical pharmacy and pharmacist care services.
Qualitative interview
39 semi-structured online interviews were conducted for the face and content validation of the model and definition. The expert panel consisted of 18 university professors with PhD or PharmD degrees (two from Yemen, five from Saudi Arabia, two from the United Arab Emirates, one from the United States, one from the United Kingdom and one from Canada, one from Australia and five from Malaysia), 15 hospital pharmacists (eight from Saudi Arabia, four from the United Arab Emirates, one from the United Kingdom, one from the United States and one from Canada) and six community pharmacists (two community pharmacists from Canada, two from the United States, two from the United Kingdom). The interview was conducted in English and Arabic languages with a period ranging from 30 minutes to 90 minutes from April 2021 to January 2022. The second draft of the model and four definitions were developed in this step; model themes are presented in figure 1 and table 1.
Delphi method
Sample size
There is no standard size of the panel members. However, the literature recommended that the Delphi panels range between 10 to 1000 will be accepted.[7] Therefore, a target of 100 experts was selected for this study.
Round 1
The invitation was sent to 120 experts from different developing and developed countries. However, only 50 university professors with PhD or PharmD degrees accepted the invitation to participate in this step (four from Yemen, 11 from Saudi Arabia, nine from Malaysia, three from Pakistan, two from Thailand, two from India, two from Jordan, two from Egypt, one from Sudan, three from Canada, two from the United States, two from the United Kingdom and, one from China, three from Lebanon, one from Oman, one from Qatar and one from Indonesia) and 20 hospital pharmacists (12 from Saudi Arabia, eight from the United Arab Emirates). The experts were asked to respond to the appropriateness of model items and definitions by email, with (yes, no, I don’t know or partially yes and write suggestions about each item and the proposed definitions, moreover, the experts were asked to rate the four definitions
Round 2 and round 3
The experts from round one were invited to participate in this round. However, four did not respond to the invitation (two professors from Yemen and two pharmacists from Saudi Arabia). The experts were asked to respond to the appropriateness of model items and definitions by email, with ( coded 1 = Extremely Important, 2 = Very Important, 3 = Moderately Important, 4 = Neutral, 5 = Slightly Important, 6 = Not very important, 7 = Not at all important) for the model items and indicate their extent of agreement with the proposed definition using a scale numbered from 1= strongly agree, 2 = agree, 3= neither agree nor disagree, 4=disagree, 5=strongly disagree. The participants were also asked to write suggestions about each item and the proposed definitions. moreover, the experts were asked to rate the five definitions. The survey was in English and conducted between March 2022 and 2020 to October 2022.
Statistical analysis
Data were entered and analyzed using SPSS version 21 (SPSS Statistics for Windows, version 21.0, IBM Corp., USA). Frequency and percentage were used for round 1; items and definitions were included in the second round of the survey if 70% or more of the participants agreed about it. Likert questions were analyzed for median, mode and interquartile range (IQR). The consensus was considered achieved if the IQR was ≤1 and the median was ≤2 (Very important).[8] The qualitative part was manually analyzed, then summarized all transcripts.