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Selection bias in pharmacy-based patient surveys
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
2014 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 23, no 2, p. 128-139Article in journal (Refereed) Published
Abstract [en]

PurposeTo evaluate if there is a selection bias in drug utilization surveys on prescription drugs regularly conducted in Swedish pharmacies, to describe the direction of this potential bias and discuss the implications for the results. MethodsAge and gender distributions within patient survey samples from drug utilization surveys conducted during 2006-2010 are compared to the age and gender distribution of all Swedish patients, receiving the same drug or drugs, as given by the Swedish Prescribed Drug Register. The differences between the proportions of patients within the age and gender segments of each pair of survey/register data were calculated. ResultsIn 25 (81%) out of 31 included surveys, patients aged 75 years or older are significantly underrepresented, as they are less likely to visit the pharmacy to collect their prescription drugs themselves and thus disqualify for the interviews. Data on women show similar results as overall survey data, whereas the underrepresentation of the oldest age group among men appears in a lower proportion of the surveys, 67%. The general consequence is a selection towards a healthier survey sample, but the consequences in the individual surveys vary, depending on what drug is being studied. ConclusionPharmacy-based patient surveys provide a convenient data collection method for patient self-reported data, but patients aged 75 years or older are consistently underrepresented. In surveys where this may influence the main research question, data should also be collected with other methods reaching the oldest patients.

Place, publisher, year, edition, pages
2014. Vol. 23, no 2, p. 128-139
Keyword [en]
patient survey, pharmacy, selection bias, drug utilization, self-report, pharmacoepidemiology
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-219194DOI: 10.1002/pds.3488ISI: 000329999100003OAI: oai:DiVA.org:uu-219194DiVA, id: diva2:698995
Available from: 2014-02-25 Created: 2014-02-24 Last updated: 2018-01-19Bibliographically approved
In thesis
1. Surveys and services: The feasibility of conducting research in Swedish community pharmacies
Open this publication in new window or tab >>Surveys and services: The feasibility of conducting research in Swedish community pharmacies
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

For the past decades, there has been a shift in community pharmacy practice from dispensing and compounding towards provision of pharmacy services. Research is important to generate evidence for new services within pharmacy practice. Pharmacy practice research can be divided in two main themes: research related to pharmacy as a data source and to the pharmacy as the object of research, respectively.

The purpose of this thesis is to increase the understanding of the conditions required for successful involvement of Swedish community pharmacy staff in pharmacy-based research, and to evaluate the data generated through a certain type of research: pharmacy-based patient surveys on drug utilization.

Specific aims were to evaluate if there is a selection bias in drug utilization surveys conducted in Swedish community pharmacies, to explore the experiences of pharmacists either conducting the surveys or recruiting patients to research on adherence-promoting services, and to describe barriers and facilitators to conducting research in community pharmacies.

Data were collected via pharmacy-based patient surveys, dispensing data, individual interviews, a cross-sectional staff survey and focus group interviews.

In community pharmacy-based surveys or services research, with the dispensed drug as the trigger for inclusion, patients aged 75 years or older are underrepresented since they less often visit the pharmacy to redeem their prescriptions themselves. Due to their perceived workload, dispensing pharmacists sometimes avoid including patients perceived as complex due to age, polypharmacy or communication difficulties. These processes contribute to a healthy selection effect in both types of research and pharmacy services not reaching the patients in most need of support with their medication.

The pharmacists were generally positive to conducting surveys and being involved in services research, but reported a perceived lack of sufficient communication and research skills, and a lack of time.

Since competing commercial priorities hamper pharmacists’ research involvement, separate research funding is an important facilitator. For surveys to include all eligible patients, services to be relevant for both practice and patients and to target the patients in most need of support with their medication, research collaboration with healthcare, other professions and across pharmacies is also necessary.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 244
Keyword
Pharmacy, Community pharmacy, Pharmaceutical services, Drug utilization research, Survey, Patient, Pharmaceutical care, Feasibility, Sweden
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-338811 (URN)978-91-513-0213-3 (ISBN)
Public defence
2018-03-10, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 10:00 (English)
Opponent
Supervisors
Available from: 2018-02-16 Created: 2018-01-19 Last updated: 2018-03-22

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