title: Factors influencing community pharmacists' likelihood to ask medication monitoring questions: A factorial survey.
abstract: BACKGROUND
  Community pharmacists are well positioned to identify and resolve medication related problems associated with chronic medication use during prescription dispensing, a process referred to as medication monitoring. Pharmacists need feedback about patient medication experiences to engage in effective monitoring, but the pharmacist's decision making process for when to ask questions to solicit this information from patients has not been established.
  
  
  OBJECTIVE
  Identify significant factors contributing to a community pharmacist's likelihood to ask medication monitoring questions at the time of refill.
  
  
  METHODS
  A factorial survey approach was used to test the effect of several pharmacist, patient, environment, drug, and past interaction factors (the domains of the Health Collaboration Model) on a pharmacist's self-reported likelihood to ask non-adherence, side effect, and effectiveness monitoring questions for 5 randomly populated refill prescription dispensing vignettes. Surveys containing the vignettes, demographic items, and a new medication monitoring attitude measure were mailed to 599 community pharmacists. Hierarchical linear regression was used to test the independent effects of the vignette and pharmacist factors.
  
  
  RESULTS
  There were 254 (42.4%) returned and usable surveys. The hierarchical linear regression models showed that adherence questioning was driven more by the vignette characteristics whereas side effect and effectiveness questioning were more driven by the pharmacist. Overall, warfarin and hydrocodone were seen as more question-worthy than fluoxetine or metoprolol. The number of additional persons waiting in the pharmacy decreased, and more days late increased the likelihood of asking the three monitoring questions. An exception was hydrocodone where early fills prompted question asking. For side effect and effectiveness questioning, being short-staffed and the prescription previously being filled more times decreased question asking likelihood.
  
  
  CONCLUSIONS
  Factorial surveys are a useful approach to independently measuring the impact of respondent and contextual variables on pharmacist judgments. Reactions to the vignettes demonstrated that multiple factors go into a pharmacist's mental model when deciding to ask a question at the time of refill. The lateness of a refill prescription was a significant cue to question asking. Pharmacies can ensure late refill information is reaching pharmacists as a means to increase in medication monitoring. Pharmacies also can design work environments and workflows conducive to question asking and prompt pharmacists to address potentially under-discussed medications.
authors.affiliation: University of Iowa College of Pharmacy, Iowa City, USA. Electronic address: matthew-witry@uiowa.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Witry
authors.affiliation: University of Iowa College of Pharmacy, Iowa City, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Doucette
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010594:Pharmacies; D010595:Pharmacists; D060735:Pharmacovigilance; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Community pharmacy; Counseling; Factorial survey; Pharmacist