Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : IC01 - IC08 Full Version

Designing a Pharmacy Accreditation Programme to Improve the Quality of Service Delivery in Pharmacies


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57787.17022
Shahram Akbari, Kamran Hajinabi, Leila Riahi

1. PhD Scholar, Department of Health Services Management, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran. 2. Assistant Professor, Department of Health Services Management, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran. 3. Associate Professor, Department of Health Services Management, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran.

Correspondence Address :
Dr. Kamran Hajinabi,
Assistant Professor, Department of Health Services Management, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
E-mail: hajinabi@srbiau.ac.ir

Abstract

Introduction: Improving service delivery has become a major goal in all healthcare settings. Accreditation can play an important role in improving service delivery, but few studies have been done on the development of pharmacy accreditation models.

Aim: To design a pharmacy accreditation programme, develop accreditation models and provide a suitable tool for improving the quality of service delivery in the pharmacy.

Materials and Methods: This study was a mixed-method study conducted from March 2019 to December 2020. A scoping review was undertaken for this study. PubMed, Google Scholar, World Health Organisation (WHO) and other related databases (like Web of Pharmacy Accreditation Organisations) were used as sources of databases, used following keywords to search documents according to MeSH terms i.e, health services administration, delivery of healthcare, accreditation and pharmacy. A structural equation modelling method was used. Based on the data extracted from the databases, a questionnaire was designed and was administered on stakeholders. The collected data was analysed using confirmatory factor analysis. Model parameters were estimated using the Full Information Maximum Likelihood (FIML) method. The model was revised on inspection of modification indices and fit statistics and experimented for construct validity, construct reliability and measurement invariance.

Results: The findings of this study were the design of a pharmacy accreditation programme that includes five dimensions of quality and safety, management and performance, training and development of human resources, procedures and environmental and equipment factors. The quality and safety dimension with a correlation coefficient of 0.92 had the greatest impact on the accreditation programme, the environmental and equipment factors had the least effect with a correlation coefficient of 0.73.

Conclusion: Simultaneous use of valid global models, the views of experts and stakeholders in this model, has provided a powerful and novel tool to improve the performance of pharmacies.

Keywords

Environmental and equipment factors, Healthcare, Health services administration, Management

Within an incorporated healthcare system, pharmacies have a central role in the improvement of public health and the reduction of health inequalities (1). Pharmacy at the end of the pharmaceutical supply chain as a retailer and a Small Business Unit (SBU) is responsible for dispensing medicines to the patients (2). As such, pharmacies operate with a dual role, acting as both a healthcare provider and retail business (3). However, pharmacy practice has changed over the decades, evolving and developing towards a role in healthcare beyond medicines supply (4). Currently, the pharmaceutical system is suffering from many dysfunctions including regular shortages of some medicines in the market, selling medicines by pharmacies without a prescription and counterfeit medicines. The existing challenges in the pharmaceutical system make it necessary to conduct several studies on the enforcement system to solve the potential problems (5).

The delivery of safe and quality healthcare services is a demanding issue (6). Improving patient satisfaction has become the main objective in all healthcare settings. Accreditation can play a significant role in improving patient satisfaction (7). There is significant evidence displays accreditation programmes improve the process of care delivering healthcare services and clinical outcomes. Accreditation programmes should be supported as a tool to improve the quality of healthcare services (8).

Most managers and politicians in health, accreditation and evaluation of health service providers consider it imperative to improve quality (9). Frey M et al., showed that accreditation has a positive effect on pharmacists perceptions of patient safety, quality of patient care, patient satisfaction, and patient relationships in pharmacies (10). A pharmacy accreditation program can enhance pharmacy performance to improve patient care and drug safety, and the importance of accreditation is dependent on the stringent application of fitting directions and regulations (11). Implementing accreditation leads to improvements in patient care (12). Many studies indicate that factors such as quality, safety, environment, service delivery and performance are effective in the accreditation programme (12),(13),(14),(15), therefore, the mentioned factors were considered as hypotheses by the researchers of this study.

Alkhateeb FM et al., concluded that in the absence of national accreditation programmes, international programmes are increasingly being used (16). Fortes MT et al., acknowledges that each model can have its own benefits for that country and the decision to choose models depends on the policies of countries (17). It is important that a theoretically valid measurement tool be available for researchers. Furthermore, pharmacy managers could use such a tool to obtain reliable feedback with a view to improving performance (18). Few studies in the world have been conducted in the field of pharmacy accreditation programme design, on the other hand, there are different pharmacy accreditation models in the international class, and each of them has specific advantages, so this study using internationally validated models can provide a comprehensive and novelty pharmacy accreditation programme. The aim of this study was to design a pharmacy accreditation programme, develop accreditation models and provide a suitable tool for improving the quality of service delivery in the pharmacy.

Material and Methods

This study was a mixed-method study conducted from March 2019 to December 2020. Scoping review, qualitative analysis, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) methods were used. The study received Ethical Clearance (IR.IAU.SRB.REC.1398.070) from the National Ethics Committee in Biomedical Research in Iran. This study was conducted in Iran between 2019 and 2020. The steps of the study were according to (Table/Fig 1).

Inclusion criteria: The inclusion criteria for scoping review were as follows: a) articles published between 1 January 2000 and 31 December 2020, b) documents and articles written in English or Persian, providing information about the pharmacy accreditation program or model, conducted in retail, business, and community pharmacy settings, c) quantitative and qualitative articles, theses and dissertations, and review articles.

Exclusion criteria: Exclusion criteria were records that did not report information about the pharmacy accreditation program or model.

a. A scoping review was undertaken for this study. PubMed, Google Scholar, World Health Organisation (WHO) and other related databases (like Web of Pharmacy Accreditation Organisations) were used as sources of databases. The authors used following keywords to search documents according to MeSH terms: health services administration, delivery of healthcare, accreditation and pharmacy.
b. A comparative study [Appendix-1] of the remaining models in the study was done in order to compare the factors and items of the model.
c. A conceptual model was designed [Appendix-2] and based on it, a self-administered questionnaire was prepared. The validity and reliability of the questionnaire were examined as follows:

The face validity of the questionnaire was confirmed by a qualitative method. The content validity examined by Lawshe and Waltz and Bausell techniques (19),(20). Accordingly, the Content Validity Index (CVI) and Content Validity Ratio (CVR) indices were examined by 15 experts [Appendix-3]. Cronbach’s alpha method was used for reliability analysis of the questionnaire. Cronbach’s alpha coefficient was 0.853.Therefore, the reliability was confirmed. At this stage, the questions that were repeated or could not obtain acceptable values based on the criteria Lawshe and Waltz and Bausell techniques (19),(20) were excluded from the study.

Study Procedure

A self-administered questionnaire in the Persian language containing 33 questions and a 5-point Likert scale was prepared as a data collection tool. The questionnaire translated into the English language is provided in [Appendix 4]. The statistical population to participate in the survey included managers and experts of the Food and Drug Administration, accreditation experts and pharmacists. The structural equation modelling requires a large sample size (21),(22), which affects sampling error (23). In a survey, the sample size can be determined according to the number of participants per item, five to ten participants per item are common (24). Assuming nine participants for each item, the sample size was estimated to be 297. Therefore, 300 samples were surveyed. Samples participated in the survey on the impact of variables in pharmacy accreditation. The inclusion criteria were people who had atleast one of two conditions as follows:

(a) Accreditation expert, and
(b) Pharmacist. In the field study, five different locations of Iran were selected to collect data, including: the centre of the country (Tehran province), the west (Kermanshah province), and the northwest (Guilan province), and the northeast (Khorasan Razavi province), and the south (Fars province). Sixty samples were selected for each location randomly. Regarding the informed consent of the participants, the researcher explained the objectives of the research to the participants, and participation in the research was optional.
(c) The Exploratory Factor Analysis (EFA) was conducted to identify the factors in the pharmacy accreditation program, Confirmatory Factor analysis (CFA) was used to ascertain the model. Exploratory factor analysis is a data-driven approach, used to determine the underlying factors of multiple observed variables (25). Confirmatory factor analysis is a type of Structural Equation Modelling (SEM) that deal specifically with measurement models. It’s almost always used during the process of scale development to examine the latent structure of a test instrument (like a questionnaire) (26).
(d) Finally, the pharmacy accreditation programme was designed.
(e) Evaluation of reliability and construct validity.

To estimate the convergent and discriminant validity, some parameters were computed. If they fulfilled the provisions of (Table/Fig 2) (27), the construct validity was confirmed.

There are numerous fit indices. A fit index delivers a global assessment of how well the collected data fit the hypothesised model. Common fit indices for a single analysis include Comparative Fit Index (CFI), Tucker-Lewis Index (TLI, or non normed fit index), and Root Mean Square Error of Approximation (RMSEA) (24).

Statistical Analysis

Statistical Analysis was done using the Statistical Package for the Social Sciences (SPSS, IBM) version 22.0, to determine the factors and variables that are under the set of each factor. Descriptive statistics were used to analyse the characteristics of the study population. The Analysis of Moment Structures (AMOS, IBM), version 23.0 used to confirm the model and evaluate the fit indices. For all statistical test p-value was set at <0.05.

Results

According to the inclusion criteria in the scoping review stage, 1,217 documents were included in to study. Out of total, 1,018 documents were excluded, as they were irrelevant or had duplicate titles. The abstracts and full texts of 199 remaining investigations were studied. Total 190 studies were excluded due to the lack of presenting a programme for pharmacy accreditation. Finally, nine relevant records were identified as the basis for the present study (Table/Fig 1).

The pharmacy accreditation models reviewed were as follows:

Board of Certification/Accreditation (BOC): This is a credentialing organisation that provides accreditation for facilities supplying patients with durable medical equipment and orthotic and prosthetic products, as well as professional certification for specialists. It was founded in 1984 and operates in the field of accreditation of medical institutions, including pharmacy accreditation (28).
Utilisation Review Accreditation Commission (URAC): It is a validated, non profit accrediting body based in Washington, DC. Its mission is to improve the quality of healthcare through leadership, innovation, measurement and accreditation (29).
The Wolters Kluwer Clinical Drug Information (WKCI) in the United States: This model believes that accreditation standards are generally organised in four aspects (30).
Centre for Pharmacy Practice Accreditation (CPPA): This is in the United States. Establishes and manages a process that leads to the use of standards for pharmacy accreditation and implements comprehensive programs such as pharmacy site accreditation, promotion, development and maintenance of principles, policies and standards. Its mission is to serve public health by raising the level of patient care services through pharmacy accreditation (31).
Pharmaceutical Society of Ireland (PSI): It is a public body established by law to protect the health, safety and welfare of patients and the public by regulating pharmacists and pharmacies in Ireland (32).
Ontario College of Pharmacists: This incorporated in 1871, is the registering and regulating body for the profession of pharmacy in Ontario. The College’s mandate is to serve and protect the public interest and hold Ontario’s registered pharmacists and pharmacy technicians accountable to the established legislation, standards of practice, Code of Ethics and policies and guidelines relevant to pharmacy practice (33).
Indian Pharmaceutical Association (IPA): This is in India, has a governmental structure constituted as the Central Council under the Pharmaceutical Act. Its main goal is to promote pharmacists as one of the most important providers of healthcare services and is committed to promoting the highest professional and ethical standards of pharmacy (34).
Accredited Drug Dispensing Outlet (ADDO): This is a donor-supported initiative led by the Tanzanian Food and Drug Authority to train and license small, privately operated retail outlets in rural and poor areas to sell a set list of essential medicines, including selected prescription drugs (35).
Malaysian Pharmaceutical Society (MPS) in Malaysia: It is a national association of pharmacists that was established in 1967 to promote and protect the dignity and interests of the pharmaceutical profession in this country. It also aims to support and promote professional standards and ethics (36).

Demographic information of participants in the survey

Of the 300 participants approached to complete the survey, 233 participated and returned their completed survey.The majority of respondents were female, 71% and 29% were male. In terms of education, 45 (19%) had a bachelor’s degree, 39 (17%) had a master’s degree, 97 (42%) had a professional degree, and 52 (22%) had a doctoral degree. Also, the expert panel consisted of 15 experts, 60% were male and 40% female, 66% had professional doctoral degrees and 34% had doctoral degrees. Demographics of participants in both the expert panel and survey are displayed in (Table/Fig 3).

Model design: The main finding of this study was the design of a pharmacy accreditation programme. (Table/Fig 4) shows the general structure of the confirmatory factor analysis of the modified pharmacy accreditation model estimates standard coefficients. As can be seen, the models included five factors (quality and safety; management and performance; training and development of human resources; procedures and environment and equipment) and 30 variables. The variables or items are shown in (Table/Fig 4).

Quality, safety and management and performance factors significantly impacted pharmacy accreditation (correlation values=0.92). Other factors also had significant effects, including training and development of human resources (correlation values=0.91), procedures (correlation values=0.86), environment and equipment (correlation values=0.73).

Model fit: The results of general fit indices of the confirmatory factor analysis reported in (Table/Fig 5). In one column of the table, general rule for acceptable fit if data is continuous was shown and in the other column, the results of fitting the current model were displayed.

The results of model fit showed that the model has a relatively good fit. Comparative Fit Index (CFI)=0.87, Tucker-Lewis Index (TLI)=0.84 and the Root Mean Square Error of Approximation (RMSEA)=0.065) also did not reach the target fit.

Construct reliability: Construct reliability is a measure of reliability in the structural equation modelling analysis.The values related to the Construct reliability and validity are given in (Table/Fig 6).

According to (Table/Fig 6), the construct reliability of all factors was more than 0.7. Therefore, reliability was established. Also, the construct reliability was larger than the average variance extracted (3), and the average variance extracted was more than 0.5. Therefore, the condition of convergence validity was met for all factors. Finally, given that the Average Variance Extracted was larger than the Maximum Shared Squared Variance (MSV), there was a discriminant validity for all factors affecting pharmacy accreditation.

Discussion

This study used a systematic approach towards accreditation model designing with stakeholder involvement, with an emphasis on aspects that are relevant to the international audience. The findings showed the accreditation of pharmacies in the framework of five factors.

The Root Mean Square Error of Approximation (RMSEA) and Comparative Fit Index (CFI) statistics provide evidence of the model’s suitability in providing a comprehensive view of accreditation programmes in pharmacies. It should be mentioned that the Tucker-Lewis Index value only just reached the desired cut-off of 0.95. A review of the literature identifies that the difficulty in attaining fit standards for complex models with high inter-correlation is well proved (37),(38),(39). This highlighted that cross-loading (When any item correlates more strongly with the other dimensions than with its own dimension, the instrument has cross-loading (40)), which is typical of highly correlated data, contributes to model misspecification and presents difficulty with adherence to Hu LT and Bentler PM strict cut-off values for model fit (41). An instrument’s acceptability should not be refused on failing to meet fit normal, but should rather be judged by an overall validity assessment using a broad analysis of multiple fit statistics, construct validity and criterion validity tests (38),(39). Future works should look to test this model in settings that would minimise inter-correlation, such as a non Service Focused Marketing Strategy (SFMS) pharmacies hypothesised to produce a more varied response set. It is predicted that data collected from such settings would thus improve model fit (38).

Many studies have emphasised the desirable role of accreditation in health service organisations (42),(43),(44),(45),(46). Alkhateeb FM et al., studied national and international accreditation programmes for pharmacies in the Gulf Cooperation Council countries, concluded that in the absence of national accreditation programmes, international programmes are increasingly being used as tools to know the power of quality (16). Fortes MT et al., compares accreditation models in several European countries and acknowledges that each method can have its own benefits for that country and the decision to choose models depends on the policies of countries (17).

A number of studies have shown that accreditation is a driver for quality improvement (47),(48),(49),(50),(51). Chapman RW, found that accreditation is a process that helps improve performance management system (15). Frey M et al., showed that the frequency of reports by pharmacists and the compatibility of quality-based methods and services after accreditation increased (10). In addition, accreditation had a positive effect on pharmacists’ perceptions of patient safety, quality of patient care, patient satisfaction, and patient relationships in reputable pharmacies. Also, a pharmacy accreditation programme using quality-based standardised best practices can create and reinforce behaviour change in the pharmacy environment (10). Bruchet N et al., in their research on the quality of 24 hour pharmacy services in 2011, indicated that these factors included the cleanliness of the environment of pharmacies and staff, safety and reliability of services or the correct provision of services, service effectiveness, and creating trust in the minds of customers regarding the operation of pharmacies (52).

Reviewing the dimensions of the present model and its compatibility with other models studied indicates that the Malaysian Pharmaceutical Society (MPS) model is most similar to the present model. The Malaysian Pharmaceutical Society model covers most aspects of accreditation and is comprehensively appropriately offered in the present model (36). The Pharmaceutical Society of Ireland (PSI) and the Indian Pharmaceutical Association (IPA) models have paid less attention to quality and safety aspects (32),(34). The utilisation Review Accreditation Commission (URAC) has led pharmacies to excellence in quality and safety by developing important and practical indicators (29). Comparing the present model with the utilisation Review Accreditation Commission (URAC) model, attention has been paid to the issue of training and empowerment of human resources, which can be important in the current situation of Iran due to the severe shortage of health personnel. Another model is the Board of Certification model in the United States (28). One of the weaknesses of the Board of Certification model is the lack of attention to the environment, particularly the health conditions of the pharmacy environment. In the proposed model, this component has been seen and considered correctly. The Ontario College of Pharmacists (OCP) model is similar to the proposed model (33). However, in the proposed model, issues related to training and empowerment of human resources and policies and methods are also seen, which can be very effective. The Accredited Drug Dispensing Outlet (ADDO) accreditation model focuses on quality, training, and employee competency considered in the proposed model (35). In addition, the proposed model pays attention to safety and policies. Comparing the Centre for Pharmacy Practice Accreditation (CPPA) model with the model proposed by the researcher, we find that in the proposed model, we have considered health indicators and pharmacy environment and policies, which can be very effective in accreditation issues (31). Comparing the Wolters Kluwer Clinical Drug Information (WKCI) model with the proposed model, we have considered the measurable components of this model in the proposed model, along with policy and education indicators (30).

Limitation(s)

There is a limitation in this study that could be addressed in future studies. The study focused on surveys of experts and pharmacists. Consumer perceptions were not included due to logistical constraints and time and resource limitations to the study. However, interviews with other stakeholder groups/consumers and the use of quantitative methods to help establish a consensus opinion may form the basis of future studies.

Conclusion

The simultaneous use of valid global models and the opinions of national experts and stakeholders in this study has provided a powerful and novel tool to improve the performance of pharmacies. The pharmacy accreditation programme designed can improve quality and safety in pharmacy. Organisations in charge of monitoring the performance of pharmacies can use this tool to accredit pharmacies.

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DOI and Others

DOI: 10.7860/JCDR/2022/57787.17022

Date of Submission: May 15, 2022
Date of Peer Review: Jul 05, 2022
Date of Acceptance: Sep 28, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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