title: Patients' willingness to use a pharmacist-provided medication management service: the influence of outcome expectancies and communication efficacy.
abstract: BACKGROUND
  Previous research has demonstrated that some patients who are at risk of experiencing medication-related problems express a lack of willingness to use pharmacist-provided medication management services. Little is known about the factors that influence willingness to use these services among patients who have not yet experienced the service.
  
  
  OBJECTIVE
  The aim of this study was to test a model of willingness to use the Australian Home Medicines Review (HMR) service. Specifically, this study aimed to determine the influence of positive and negative outcome expectancies and communication efficacy over willingness among patients who were eligible to receive the service but have not yet experienced it.
  
  
  METHODS
  A cross-sectional survey was conducted with patients who were recruited by 264 community pharmacists throughout Australia. Patients were included in the study if they had not yet experienced HMR but were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed using exploratory and confirmatory factor analyses. Structural equation modeling was used to test the model.
  
  
  RESULTS
  Questionnaires received from 286 patients (15.6%) were analyzed. Multi-item measurement scales were observed to have acceptable construct reliabilities (range, 0.69-0.94). Importantly, respondents held overall neutral expectations about the personal benefits of HMR (positive outcome expectancies) but high communication efficacy. Structural equation modeling revealed that positive outcome expectancies (β=0.56, P<.001) and communication efficacy (β=0.25, P<.05) influenced willingness to use, whereas negative outcome expectancies had no significant effect.
  
  
  CONCLUSIONS
  The extent to which patients believe that HMR would provide them with increased medicines knowledge, improve their medicines management capability, and reduce their medicine concerns had a significant influence over willingness to use the service. Because these expectancies are relatively low, there appears to be significant scope for increasing patient demand for these services. Patient-directed material about medication management services should highlight the provision of medication information.
authors.affiliation: Faculty of Pharmacy, The University of Sydney, NSW, Australia. scar4376@uni.sydney.edu.au
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carter
authors.forename: Rebekah
authors.initials: R
authors.lastname: Moles
authors.forename: Lesley
authors.initials: L
authors.lastname: White
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D003142:Communication; D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D054539:Medication Therapy Management; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D061214:Patient Safety; D010361:Patients / Q000523:psychology*; D010595:Pharmacists / Q000523:psychology*; D019338:Polypharmacy; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires