In this lecture, you will learn which methods professionals use when they want to learn about, and evaluate the patient perspective on medications. The aspects that professional are typically interested in when it comes to the patient perspective on medications are satisfaction with health care services including pharmacy services, beliefs, attitudes, knowledge and behaviors regarding medicines use. Health-related quality of life and medicines-related quality of perspectives including the burden of medicines and the quality of life related to using medicines. In broad terms, there are two ways to explore these aspects, the quantitative and the qualitative approaches. The quantitative approach can roughly be divided into satisfaction surveys, questionnaires, and scales about beliefs, attitudes, knowledge and behaviors regarding medicines, and patient reported outcomes measures and health-related quality of life, and burden of medicine and medicine-related quality of life questionnaires. The qualitative or open-ended methods are where professionals seek to understand the reasons behind patients' behaviors and their perspectives on medications in a more in-depth manner. Here, they attempt to tap into the lived world of the patient by asking them open-ended questions about their medicines use. In this lecture, we will look at the quantitative methods, professionals use when evaluating the patient perspective. You will hear more about the qualitative methods in Module 4. Quantitative questionnaires are widely used in the health care system and can be seen as a structured way of asking patients questions that require closed-ended answers. Here, is an example of such a question from the well-known beliefs about medicines questionnaire. Health care providers and health care organizations often wish to know whether the patients are satisfied with their services. Patient satisfaction surveys are quantitative assessment of satisfaction with health care services of any kind. They are meant to be a tool for quality improvement by identifying shortcomings in the care. In other words, if you find out many service users are not satisfied with a certain aspect of the service, you need to do something about it as a health care provider. The patient satisfaction surveys have been criticized for their shortcomings. For instance, they are formulated by the professionals and therefore do not adequately address the patient perspective. It is the professionals who decide which questions to ask, without looking at what matters to patients, but only what matters from their professional perspective. Secondly, satisfaction service do not delve into the critical events that patients experience and use these events to improve the services provided. Lastly, the satisfaction service results in what we call acquiescence. This means that the people may agree without really wanting to agree with the statements because they are not given the opportunity to respond in a nuanced way. This may lead to service often measuring very high satisfaction. That in turn gives a false sense that everything is going well. Therefore, patient satisfaction surveys often cannot be used for quality improvement within health care. This includes improving pharmacy services or helping people with their medicines use. Health care professionals have been interested in measuring what people know about medicines, what they believe about them, and how they behave regarding medicines. These are a few of the concepts these questionnaires or scales are used for measuring. For beliefs and attitudes towards medicines, the two main concepts of interest have been, on the one hand, patients' concerns with medicines and, on the other hand, how they perceive the benefit of medicines. A few widely used and tested tools are available for this purpose since these concepts can often predict or correlate with behaviors such as adherence to medicines. Adherence or non-adherence has had much attention. Measuring adherence can be done in many ways. This is an attempt at getting the patients' estimate of their own adherence, but these are still very much based on the health care professional perspective. These types of scales are currently mostly used in research and not directly in the clinic, although they could give an indication of aspects that the clinician can take into account. Patient reported outcomes or PROs are another important concept that health authorities have been particularly interested in measuring. Among these are the health related quality of life questionnaires. These questionnaires are part of a movement towards a more citizen-centered care, where it is important to measure how medicines and other health care interventions impact on patients' lives. In order to better allocate resources within health care systems, we need to know what 'value' means in health care. An important stakeholder that can tell us what is valued is the patient. To measure how the individual patient values the outcomes, good or bad, of their treatment, we use PROs. These are directly reported by the patient without interpretation of the patient's response by the clinician or anyone else. It has to do with the patient's health, quality of life, functional status, symptoms, or symptom burden associated with health care or treatment. Patient reported outcomes measures, also called PROMs, are divided into generic measures and disease-specific measures. Generic measures allow comparison across various medical conditions to assist the evaluation and implementation of new methods of providing care and to ensure equity of service delivery. Some of these generic measurement tools are also widely used in economic evaluations of effects of medicines on patients. Disease or condition specific measures are useful as they are better able to measure the disease outcomes closer to the patient's real life situation. To take an example of a generic PROM, the EQ-5D is an internationally well-known scale to measure health-related quality of life. The scale allows for health economic evaluations by adding the value of the patient to the evaluation of the treatment. Here, you see an example of an item on the EQ-5D survey related to pain and discomfort. There are many disease-specific PROMs and they're usually identifying specific symptoms and their impact on specific health conditions or diseases. They often have greater validity and credibility than the generic PROMs because they can get closer to the reality of living with a particular disease. The drawback is that comparisons cannot be made across a variety of conditions and they cannot be used to compare the cost and outcomes of treating various diseases and, therefore, cannot be used in prioritizing in health care. The methods we have looked at so far are all used to measure concepts related to the diseases or conditions of patients. But there are now a few instruments available that measure the burden that medicines pose on patients. That is, how it is to live with medicines day to day, as well as other aspects of quality of medicines used as valid by patients. Most of the scales are currently being tested for validity and have not been used to an extent that allows us to understand whether they in reality can give us insights into how patients live with and value medicines. But work is in progress. This was all for now on quantitative ways of evaluating the patient perspective on medications through the use of questionnaires and scales. A few of these scales you will find in your further reading material. Thank you for your attention.
