Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 Session 8. Understanding the Problems Associated with Medicine Use— Qualitative Methods Drug and Therapeutics Committee.

Similar presentations


Presentation on theme: "1 Session 8. Understanding the Problems Associated with Medicine Use— Qualitative Methods Drug and Therapeutics Committee."— Presentation transcript:

1 1 Session 8. Understanding the Problems Associated with Medicine Use— Qualitative Methods Drug and Therapeutics Committee

2 Objectives  Identify four methods used to investigate reasons underlying medicine use and prescribing behavior  Understand the use of qualitative methods to identify why documented medicine use problems occur  Design a simple qualitative instrument to investigate medicine use

3 Outline  Introduction  Applying qualitative methods to medicine use studies  Qualitative methods  Focus group discussions  In-depth interviews  Structured observations  Structured questionnaires  Activities  Summary

4 Introduction (1)  Quantitative study methods identify presence of medicine use problems  Indicator studies  Aggregate data: DDD, ABC, VEN  Record review and DUE  What else is needed to plan an intervention?  Need to know why the problem exists, that is, qualitative methods

5 Introduction (2)  Four qualitative study methods  Focus group discussions  In-depth interviews  Structured observations  Questionnaires

6 Applying Qualitative Methods (1)  Complement results of a quantitative study  Explore a topic about which little is known  Provide background data before developing training materials for a planned educational intervention and for developing managerial and regulatory interventions

7 Applying Qualitative Methods (2) Example of using qualitative methods  Prescribing by brand name was very popular at the district hospital. Despite numerous interventions including face-to-face discussions, in-service education, policy and procedures changes, physicians continued to prescribe by brand name.  Using qualitative methods, investigators discovered that physicians were receiving educational “benefits” from pharmaceutical companies in exchange for theicorrected once the reasons for the medicine use behavior became known.

8 Some Factors Influencing Medicine Use MEDICINE USE Cultural Beliefs Knowledge Deficits Unbiased Information Relation With Peers Authority & Supervision Influence of Industry Workload & Staffing Infra- structure Acquired Habits Patient Demand Interpersonal Workplace Workgroup Personal Informational

9 Focus Group Discussions (1)  A short discussion (1–2 hours) led by a moderator in which a small groups of respondents (6–10) talk in depth about topics of interest  A trained moderator leads the discussion and encourages participants to reveal underlying opinions, attitudes, and reasons for the problem being studied  The discussion is recorded and analyzed to identify key themes and issues

10 Focus Group Discussions (2)  6–10 participants who share similar characteristics (e.g., age, gender, type of work)  Locale convenient to participants and one in which they will feel comfortable  Number of focus groups discussions should be sufficient to gain the views of all the various target groups involved in the medicine use problem  Moderator and recorder must be skilled and trained

11 Focus Group Discussions (3)  Advantages  Relatively cheap and easy to organize  Identifies a range of beliefs and ideas  Disadvantages  Group may not represent the larger population  Success depends on the skill of the moderator

12 In-depth Interview (1)  An extended discussion between a respondent and an trained interviewer (who is knowledgeable about the topic) based on a brief interview guide that usually covers 10–20 topics  The interview is flexible and often unstructured  The questions are open ended to encourage the interviewee to talk at length on the topic of interest  5–10 interviews with each important subgroup, often opinion leaders and key informants

13 In-depth Interview (2)  Advantages  Can develop trust between interviewer and interviewee  Possible to probe deeper and therefore gain unexpected insights or new ideas  Can reveal unsought, but significant, data  Disadvantages  Generates lots of data and analysis may be difficult and time consuming  Interviewees may give answers they think the interviewer wants to hear

14 Structured Observation (1)  Systematic observations by trained observers of a series of encounters between health providers and patients  Observers record in structured manner behaviors and impressions they witness during the encounters or they record a score for each observed interaction  Data may be recorded as coded indicators and scales or lists of behaviors and events, and then frequency of behaviors may be calculated

15 Structured Observation (2)  To prepare for the study, the observer should provide a nonthreatening explanation and spend time “blending in”  At least 30 encounters should be observed to calculate the frequency of behaviors  At least 10 sites should be visited to observe behavior

16 Structured Observation (3)  Advantages  Best way to study the complex provider-patient interactions, including patient demand and quality of communication  Can learn about provider behavior in natural setting  Data on actual—rather than reported—behavior collected  Disadvantages  Observed providers may modify their behavior because of observer’s presence  Requires skilled, patient observers  Inappropriate for infrequent behaviors

17 Structured Questionnaire (1)  A fixed set of questions asked to a large sample of respondents selected according to strict rules to represent a larger population  The questions have a fixed set of responses or options to collect the desired information in a standard way from all respondents  The questionnaire may be administered by an interviewer or filled out alone by the respondent

18 Structured Questionnaire (2)  At least 50–75 respondents from each target group  Respondents chosen randomly  Training and supervision of interviewers required  Questions asked in a standardized way; no leading questions

19 Structured Questionnaire (3)  Advantages  Best for measuring strength and frequency of attitudes, beliefs, knowledge, and population characteristics  Can generalize to a wider population  Disadvantages  Does not uncover the unexpected  Sensitive to the way questions are phrased leading to possible bias; respondents may answer even when they have no true opinion  Large surveys are expensive

20 Activity 1  What qualitative methods can be used to investigate the reasons underlying a particular behavior?  What questions should be asked in—  An in-depth interview with a prescriber?  A questionnaire with an exiting patient?  What activities should be observed during the—  Consultation  Dispensing process  Group work followed by plenary discussion

21 Activity 2  Antibiotic consumption in your hospital is high and often unnecessary, according to a recent prescription audit  Each group will develop one qualitative instrument to investigate the reasons underlying antibiotic overuse  In-depth interview with prescribers  Structured interviews with exiting patients  Structured observation of the consultation  Each group to role-play based on the instrument  During each role-play, everyone to note the following:  Was the instrument clear?  Did the instrument detect an underlying motive?

22 Summary  Before an intervention can be designed to correct poor practice or irrational use of medicines, need to know why that behavior is occurring  Qualitative methods should be used to investigate the behavior from different perspectives and with regard to different actors (e.g., patients, staff)  Triangulation of results using different methods should be done to identify the major reasons underlying a particular behavior


Download ppt "1 Session 8. Understanding the Problems Associated with Medicine Use— Qualitative Methods Drug and Therapeutics Committee."

Similar presentations


Ads by Google