Primary Care Pharmacy September 2000 Vol 1 No 4 p112-113
Articles
Pharmaceutical needs assessment - easier said than done?
By Sharon E Williams PhD, MRPharmS
This article looks at one way of going about a pharmaceutical needs assessment
Needs assessment is the process of measuring health needs in a population. It is fundamental to local commissioning of services and to effective practice planning. It helps decision-makers to prioritise changes and make the best use of resources in an evidence-based manner. Some of the questions that may spring to mind when contemplating undertaking a pharmaceutical needs assessment are why do it? Where to begin? and how to start?
Why do an assessment?
As any practice pharmacist will confirm, there are a myriad of pharmaceutical services that can be provided (see Panel 1),1 yet there has been a tendency for efforts to be concentrated on areas that can realise immediate efficiency or cost savings. For example, by formulary management or switching from proprietary to generic preparations.2 However, without some form of systematic evaluation of need, it is entirely possible that greater unmet pharmaceutical needs within a practice (for example, medication review, patient education or concordance problems) have been sacrificed in favour of this “quick fix” approach. Pharmaceutical needs assessment allows identification of the varying needs of a practice population and assists the prioritisation, planning and delivery of services in the most resource effective way. It introduces openness and accountability into the process of service selection.
Where to start
A variety of techniques3-8 to assess health needs have been used but as stated by McEwen et al, “…there is no single best method of assessing health needs — different issues and questions require different methods and approaches and degrees of detail and different combinations of professionals to be involved.”9
A pharmaceutical needs assessment method, designed for ease of use, has recently been published, which includes a combination of techniques.1 These include “gap analysis”,3 the “nominal group technique”,4 and “rapid participatory appraisal”.5
In summary, through a four-stage process, which incorporates the views
of patients and their primary health care providers (GPs, nurses, community
pharmacists, practice administration staff), this method allows the construction
of a service “priority” league table, around which pharmaceutical
service provision within a practice can be planned.
Stage one comprises a face-to-face, semi-structured interview with patients
and primary health care professionals to determine their perceived need
for particular pharmaceutical services. Stage two is a postal questionnaire
to the various groups in stage one, which is designed to identify the
degree of desirability of varying pharmaceutical services identified at
stage one, as well as other services that were not identified in stage
one. Stage three is an open forum discussion of results from stages one
and two, where agreement is reached on an overall “priority”
league table based on patients’ and health care professionals’
perceived needs. Finally, having identified and prioritised the areas
of pharmaceutical perceived need, the fourth stage of the assessment process
is to use the “priority” league table from stage three in the
final selection of pharmaceutical care to be provided. This method was
found to be successful in designing a pharmaceutical service for a six-partner
practice tailored to local need. This was preferable to implementing a
service on the basis of need expressed elsewhere. The approach used balanced
what should be done with what could be done and what could be afforded.
Importantly, it provided a formal mechanism for patients to have a say
in the service they received and opened up interprofessional communication
channels.
How to start
When considering undertaking a needs assessment for the first time it is easy to become overwhelmed by the sheer volume of work but it is rather like the old joke “How do you eat an elephant?” answer — “piece by piece”, this then raises the question “Which piece do you start with?”
Some guiding principles are:
- Be focused in what you are trying to achieve. For example, do you want to evaluate the need for all service provision or to prioritise selected services?
- Construct a steering group made up of individuals who work in the practice or practice area, have a particular knowledge, skill or expertise or can represent local people and/or decision-makers
- Consider what resources will be needed to undertake the assessment and where they will come from. For example, the patient postal survey component of the aforementioned pharmaceutical needs assessment cost £1,850. However, it was felt that this aspect of the pharmaceutical needs assessment could be forfeited if time and resources were constrained, as the results (from the postal survey) appeared to validate the range of issues raised during the selected patient interviews in stage one
- Your needs assessment will be aiming to influence a decision or process, so your project must be timed to produce the necessary results at the right time. Identify when the decision process will take place and work backwards from your deadline to produce a project management timetable
- Define the client groups you will be targeting in the assessment and be clear why you have selected them.
The scope of this article is intended to give a flavour of why and how to do a pharmaceutical needs assessment. Those intending to undertake this type of assessment should refer to an original publication,1 which describes practical detail. Copies of the needs assessment tools used at our primary care group are available on request.