Model And Measurement Of Shared Decision Making In Web-based Pharmaceutical Care Consulation

[Purpose]In the setting of irrational use of drugs,abolishing drug additions and the strained physician-patient relationship,pharmaceutical care and shared decision making(SDM)can improve medication compliance and satisfaction,and promote physician-patient relationship.At the same time,in the tide of Internet&medicine development,web-based pharmaceutical care consulation has become a new form.However,there is little theoretical framework to guide SDM practice in web-based pharmaceutical care consulation and research on evaluating the level of SDM in web-based pharmaceutical care consulation.Therefore,this study is aimed to construct the model and measurement of SDM in web-based pharmaceutical care consulation.[Methods]In this study,we first used strict criteria to summarize the existing SDM theoretical models through the literature published before 31 July 2019.Based on theory appraisal tool of SDM model,we evaluated eight aspects(21 criteria)of the model,such as the origin,meaning and development process.After the analysis of these SDM models and understanding the characteristics of web-based pharmaceutical care consulation by depth interview,we constructed the theoretical model of SDM in web-based pharmaceutical care consulation.Based on the formed theoretical model,we developed the dimension and items of the measurement referring to Hinkin's scale construction process.Target groups evaluated the appropriateness of the dimensions and items,and Spearman correlation coefficient,Pearson correlation coefficient,Multiple Indictors Multiple Causes(MIMIC)model were used to evaluate reliability and validity of the measurement based on empirical data,respectively.Partial Least Squares Structural Equation Modeling(PLS-SEM)was used to validate the model,and multi-group PLS-SEM was used to verify whether the model was invariant in different pharmaceutical care providers(PCPs)and drug-related problems(DRPs).TOPSIS was used to calculate the index of SDM in web-based pharmaceutical care consulation,and analyze whether the index was different in different PCPs and consulting different DRPs.[Results]“Literature review and model appraisal”:The literature review included 31 SDM theoretical models.The construction of the Implementation-SDM model was based on the communication between doctors trained by SDM and patients with chronic kidney disease or breast cancer,and this model developed the SDM theoretical model that is Three Talk model.Implement-SDM model with good quality could be a basis for measurement of SDM in routine care.“Theoretical model”:Theoretical model SDM in web-based pharmaceutical care consulation included the following four elements:"Comprehensive understanding the patient's condition","Exchanging ideas on medication option","Achieving a medication plan",and"Providing decision support".“Measurement”:Measurement of SDM in web-based pharmaceutical care consulation included 4 dimensions and 19 items.We found good content validity,inter-rater reliability,single-item validity,and convergent validity of this measurement by appropriateness score,Spearman correlation coefficient,Pearson correlation coefficient and MIMIC model.“Empirical model”:PLS-SEM was used to validate the following 4 hypotheses of the theoretical model SDM in web-based pharmaceutical care consulation:Hypothesis 1:"Comprehensive understanding the patient's condition"promotes"Exchanging ideas on medication option";Hypothesis 2:"Exchanging ideas on medication option"promotes“Achieving a medication plan”.Hypothesis 3:“Providing decision support”promotes"Exchanging ideas on medication option";Hypothesis 4:“Providing decision support”promotes"Achieving a medication plan".Hypothesis 1(path coefficient=0.333;P=0.000;?~2=0.125)and hypothesis 2(path coefficient=0.658;P=0.000;?~2=0.762)were verified.However,the path coefficients of Hypothesis 3 and Hypothesis 4 were not significant.Multi-group PLS-SEM analysis showed that the two path coefficients of the model of different PCPs and consulting different DRPs were significant,and the path coefficients of different PCPs were identical.However,the path coefficients of consulting different DRPs were not identical.“Index”:The mean of index of SDM in web-based pharmaceutical care consulation was 25.50(standard deviation=11.246).We found that the difference between different PCPs was significant(P=0.00),but the difference between consulting different DRPs was not significant(P=0.297).[Conclusions]Implement-SDM model with good quality was suitable for guiding measurement,which provided research basis for the construction of model and measurement of SDM in web-based pharmaceutical care consulation.Caracteristics of web-based pharmaceutical care consulation,highlighting the importance of medication history,medication regimen and detailed medication plan,were observed in theoretical model in this study compared with previous SDM models.Measurement of SDM in web-based pharmaceutical care consulation in this study had good reliability and validity.“Comprehensive understanding the patient's condition"promotes"Exchanging ideas on medication option"and"Exchanging ideas on medication option"promotes“Achieving a medication plan”,which provides a framework to guide the practice of SDM in web-based pharmaceutical care consulation.The Level of the index of SDM in web-based pharmaceutical care consulation was not optimistic,so further training and improvement of pharmaceutical care and SDM are still needed.[Innovation and Deficiency]For the innovation,first,the theoretical model proposed in current study was developed by a series rigorous approaches.Caracteristics of web-based pharmaceutical care consulation were observed in theoretical model in this study compared with the existing SDM models,which enriches SDM theory.This study verified the model by quantitative analysis,which increases the applicability of the model in practice.Second,combined with Hinkin's scale construction process,the measurement of SDM in web-based pharmaceutical care consulation was developed and evaluated for improving the measurement quality,which enriches SDM measurement.Compared wih the level of index of SDM in web-based pharmaceutical care consulation between two different PCPs(physicians,pharmacists),we found the advantages and disadvantages of pharmacists in web-based pharmaceutical care consulation for providing policy basis to improve pharmaceutical care from pharmacists.For the deficiency,first,we mainly concerned the patients with hypertension or high blood pressure,so the results of the model and measurement in crruent study need to be verified in other diseases.Second,there was limited empirical data about the pharmacist-patient communication in Internet,and the pharmacists mainly came from the easternregion in China.Therefore,the results of model need to be verified in other regions.Third,the construction and validation of the model mainly focused on an encounter and did not distinguish the source of patients.In the future,the construction and validation of the model are needed to consider multiple communication for feedback and the source of patients.