What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

A conceptual framework of patient satisfaction with a pharmacy adherence service

Background Patients do not adhere to their medicines for a host of reasons which can include their underlying beliefs as well as the quality of their interactions with healthcare professionals. One way of measuring the outcome of pharmacy adherence services is to assess patient satisfaction but no questionnaire exists that truly captures patients' experiences with these relatively new services. Objective Our objective was to develop a conceptual framework specific to patient satisfaction with a community pharmacy adherence service based on criteria used by patients themselves. Setting The study was based in community pharmacies in one large geographical area of the UK (Surrey). All the work was conducted between October 2008 and September 2010. Methods This study involved qualitative non-participant observation and semi-structured interviewing. We observed the recruitment of patients to the Medicines Use Review (MUR) service and also actual MUR consultations (7). We also interviewed patients (15). Data collection continued until no new themes were identified during analysis. We analysed interviews to firstly create a comprehensive account of themes which had significance within the transcripts, then created sub-themes within super-ordinate categories. We used a structure-process-outcome approach to develop a conceptual framework relating to patient satisfaction with the MUR. Favourable ethical opinion for this study was received from the NHS Surrey Research Ethics Committee on 2nd June 2008. Results Five super-ordinate themes linked to patient satisfaction with the MUR service were identified, including relationships with healthcare providers; attitudes towards healthcare providers; patients' experience of health, healthcare and medicines; patients' views of the MUR service; the logistics of the MUR service. In the conceptual framework, structure was conceptualised as existing relationships, environment, and time; process was conceptualised as related to recruitment and consultation stages; and outcome as two concepts of immediate patient outcomes and satisfaction on reflection. Conclusion We identified and highlighted factors that can influence patient satisfaction with the MUR service and this led to the development of a conceptual framework of patient satisfaction with the MUR service. This can form the basis for developing a questionnaire for measuring patient satisfaction with this and similar pharmacy adherence services. Impact of findings on practice * Pharmacists and researchers can access the relevant ideas presented here in relation to patient satisfaction with pharmacy adherence services. * Researcher can use the conceptual framework as a basis for measuring the quality of pharmacy adherence services. * Community pharmacists can improve the quality of healthcare they provide by realizing concepts relevant to patient satisfaction with adherence services.

Customer satisfaction and organisational justice

Applies organisational justice theory to facilities management with the aim of increasing customer satisfaction with the service received. Provides an overview of organisational justice theory, and reviews the numerous different forms that this may take. Although there is strong theoretical support for participative decision making, in practice it often leads to conflict and delays. Two-way communication appears to represent the most effective form. The conclusions are based upon theoretical support as well as semi-structured interviews and observations in an organisational setting. The conclusions drawn do not have the benefits of more objective quantitative research methods. Contributes to practical understanding of how to maintain customer satisfaction in the facilities management industry and the theoretical reasons why the proposed methods will be effective. Argues that the impact of organisational justice on employee satisfaction can be applied to customer satisfaction with specific reference to facilities management.

Verification of design calculations of a wind catcher/tower natural ventilation system with performance testing in real building

A wind catcher/tower natural ventilation system was installed in a seminar room in the building of the School of Construction Management and Engineering, the University of Reading in the UK . Performance was analysed by means of ventilation tracer gas measurements, indoor climate measurements (temperature, humidity, CO2) and occupant surveys. In addition, the potential of simple design tools was evaluated by comparing observed ventilation results with those predicted by an explicit ventilation model and the AIDA implicit ventilation model. To support this analysis, external climate parameters (wind speed and direction, solar radiation, external temperature and humidity) were also monitored. The results showed the chosen ventilation design provided a substantially greater ventilation rate than an equivalent area of openable window. Also air quality parameters stayed within accepted norms while occupants expressed general satisfaction with the system and with comfort conditions. Night cooling was maximised by using the system in combination with openable windows. Comparisons of calculations with ventilation rate measurements showed that while AIDA gave reasonably correlated results with the monitored performance results, the widely used industry explicit model was found to over estimate the monitored ventilation rate.

An evaluation of the UK Food Standards Agency's salt campaign

Excessive salt intake is linked to cardiovascular disease and several other health problems around the world. The UK Food Standards Agency initiated a campaign at the end of 2004 to reduce salt intake in the population. There is disagreement over whether the campaign was effective in curbing salt intake or not. We provide fresh evidence on the impact of the campaign, by using data on spot urinary sodium readings and socio-demographic variables from the Health Survey for England over 2003–2007 and combining it with food price information from the Expenditure and Food Survey. Aggregating the data into a pseudo-panel, we estimate fixed effects models to examine the trend in salt intake over the period and to deduce the heterogeneous effects of the policy on the intake of socio-demographic groups. Our results are consistent with a previous hypothesis that the campaign reduced salt intakes by approximately 10%. The impact is shown to be stronger among women than among men. Older cohorts of men show a larger response to the salt campaign compared to younger cohorts, while among women, younger cohorts respond more strongly than older cohorts.

Integrating pests and pathogens into the climate change/food security debate

While many studies have demonstrated the sensitivities of plants and of crop yield to a changing climate, a major challenge for the agricultural research community is to relate these findings to the broader societal concern with food security. This paper reviews the direct effects of climate on both crop growth and yield and on plant pests and pathogens and the interactions that may occur between crops, pests, and pathogens under changed climate. Finally, we consider the contribution that better understanding of the roles of pests and pathogens in crop production systems might make to enhanced food security. Evidence for the measured climate change on crops and their associated pests and pathogens is starting to be documented. Globally atmospheric [CO(2)] has increased, and in northern latitudes mean temperature at many locations has increased by about 1.0-1.4 degrees C with accompanying changes in pest and pathogen incidence and to farming practices. Many pests and pathogens exhibit considerable capacity for generating, recombining, and selecting fit combinations of variants in key pathogenicity, fitness, and aggressiveness traits that there is little doubt that any new opportunities resulting from climate change will be exploited by them. However, the interactions between crops and pests and pathogens are complex and poorly understood in the context of climate change. More mechanistic inclusion of pests and pathogen effects in crop models would lead to more realistic predictions of crop production on a regional scale and thereby assist in the development of more robust regional food security policies.

Post-occupancy evaluation studies in recently refurbished office building: energy performance and employees' satisfaction

Existing buildings contribute greatly to global energy use and greenhouse gas emissions. In the UK, about 18% of carbon emissions are generated by non-domestic buildings; sustainable building refurbishment can play an important role in reducing carbon emissions. This paper looks at the performance of a recently refurbished 5-storey office building in London, in terms of energy consumption as well as occupants’ satisfaction. Pre- and post-occupancy evaluation studies were conducted using online questionnaire surveys and energy consumption evaluation. Results from pre-occupancy and post-occupancy evaluation studies showed that employees, in general, were more satisfied with their work environment at the refurbished building than with that of their previous office. Employees’ self-reported productivity improved after the move to Elms House. These surveys showed a positive relationship between employees’ satisfaction with their work environment and their self-reported productivity, well-being and enjoyment at work. The factor that contributed to increasing employee satisfaction the most was: better use of interior space. Although the refurbishment was a success in terms of reducing energy consumption per m2, the performance gap was almost 3 times greater than that estimated. Unregulated loads, problems with building control, ineffective use of space and occupants’ behaviour are argued to be reasons for this gap.

Post-occupancy studies of an office environment: Energy performance and occupants’ satisfaction

It is generally accepted that the physical workplace environment affects employees’ satisfaction and, consequently, their perceived productivity and well-being. This study investigated whether employee “satisfaction” variables can predict perceived productivity, well-being and enjoyment at work, and if so, to what extent. The study also explored whether limiting employees’ control over their environment could save energy without compromising employees’ satisfaction and perceived productivity. Preoccupancy and post-occupancy evaluation studies were conducted, in terms of both energy consumption and employee perceptions, to make comparisons between a company’s old and current headquarters buildings, both located in the same area of London. The results showed that employees were more satisfied with their work environment at their new HQ, in general, than with that of their previous office. Also, employees’ self-reported productivity, well-being and enjoyment at work improved after the move. It was revealed that the combination of employees’ level of satisfaction with “interior use of space” and “physical conditions” was the best predictor of their perceived productivity, while satisfaction with “indoor facilities” was not a good predictor. In terms of energy performance, although the new HQ’s energy consumption per m2 was significantly less than that of the previous building, there was still a gap between the refurbishment design target and the actual performance of the building. The findings suggest that this gap could be due to a number of factors, including an ineffective use of interior space, and occupants’ behaviour.

Determinants of satisfaction amongst tenants of UK Offices

Purpose – Corporate Occupiers require offices and services which meet their business needs, whilst landlords must attract and retain occupiers in order to maximise occupancy and rental income. The purpose of this research is to help landlords and corporate occupiers understand each other better, in order to achieve a mutually beneficial relationship. Design/methodology/approach - This paper analyses interviews with 1334 office tenants in the UK, conducted over an 11-year period, to investigate determinants of occupier satisfaction, loyalty and advocacy. Structural equation modelling and regressions are performed using respondents’ ratings of satisfaction with many aspects of occupancy as explanatory variables. The dependent variables include satisfaction with property management, value for money, overall occupier satisfaction, lease renewal intentions and occupiers’ willingness to recommend their landlord. Findings - The aspects with most impact on occupiers’ satisfaction are the office building itself, its location and amenities, and also communication with their property manager, a belief that their business needs are understood and the property manager’s responsiveness to occupiers’ requests. Occupiers’ loyalty depends mainly upon feeling that their rent and service charges provide value for money, an amicable leasing process, the professionalism of their property manager and the Corporate Social Responsibility of the Landlord. ‘Empathy’ is crucial to occupiers’ willingness to recommend their landlord, and clear documentation and efficient legal process improve occupiers’ perception of receiving ‘Value for Money’. Research Limitations - The sample is skewed towards occupiers of prime office buildings in the UK, owned by landlords who care sufficiently about their tenants to commission studies into occupier satisfaction. Practical implications - This research should help to improve the landlord – tenant relationship, benefitting the businesses that rent property and helping building managers understand where to focus their efforts to achieve maximum effect on occupier satisfaction, loyalty and advocacy. Originality/value - There has been little academic research into the determinants of satisfaction of occupiers of UK commercial property. This large-scale study enables the most influential factors to be identified and prioritised.

Private industrial project management: a systems-based case study

The technique of linear responsibility analysis is used for a retrospective case study of a private industrial development consisting of an extension to existing buildings to provide a warehouse, services block and packing line. The organizational structure adopted on the project is analysed using concepts from systems theory which are included in Walker's theoretical model of the structure of building project organizations (Walker, 1981). This model proposes that the process of building provision can be viewed as systems and subsystems which are differentiated from each other at decision points. Further to this, the subsystems can be viewed as the interaction of managing system and operating system. Using Walker's model, a systematic analysis of the relationships between the contributors gives a quantitative assessment of the efficacy of the organizational structure used. The causes of the client's dissatisfaction with the outcome of the project were lack of integration and complexity of the managing system. However, there was a high level of satisfaction with the completed project and this is reflected by the way in which the organization structure corresponded to the model's propositions.

A project managed by a multi disciplinary practice: a systems based case study.

The technique of linear responsibility analysis is used for a retrospective case study of a private industrial development consisting of an engineering factory and offices. A multi-disciplinary professional practice was used to manage and design the project. The organizational structure adopted on the project is analysed using concepts from systems theory which are included in Walker's theoretical model of the structure of building project organizations (Walker, 1981). This model proposes that the process of buildings provision can be viewed as systems and sub-systems which are differentiated form each other at decision points. Further to this, the sub-systematic analysis of the relationship between the contributors gives a quantitative assessment of the efficiency of the organizational structure used. There was a high level of satisfaction with the completed project and this is reflected by the way in which the organization structure corresponded to the model's proposition. However, the project was subject to string environmental forces which the project organization was not capable of entirely overcoming.

Issues of water supply and contemporary urban society: the case of Greater Amman, Jordan

Over the last two decades, Jordan has suffered a chronic water crisis, and is the tenth most water-scarce nation on Earth. Such water stress has been well illustrated in the case of Greater Amman, the capital, which has grown dramatically from a population of around 2000 in the 1920s, to 2.17 million today. One of the distinctive characteristics of the water supply regime of Greater Amman is that since 1987 it has been based on a system of rationing, with households receiving water once a week for various durations. Amman is highly polarized socio-economically, and by means of household surveys, both quantitative and qualitative, conducted in high- and low-income divisions of the city, a detailed empirical evaluation of the storage and use of water, the strategies used by households to manage water and overall satisfaction with water supply issues is provided in this paper, looking specifically at issues of social equity. The analysis demonstrates the social and economic costs of water rationing and consequent management to be high, as well as emphasizing that issues of water quality are of central importance to all consumers regardless of their socio-economic status within the city.

Post occupancy evaluation of a building employing windcatchers for summer ventilation

A combined windcatcher and light pipe (SunCatcher) was installed in the seminar room at the University of Reading, UK. Monitoring of indoor environment in real weather conditions was conducted to evaluate the application of windcatchers for natural ventilation. In addition, a subjective occupancy survey was undertaken. External weather conditions and internal indoor air quality indicators were recorded. The “tracer-gas decay” method using SF6 was used to establish air change rate for various conditions. The results indicated that the ventilation rate achieved through the windcatcher depends on the difference between internal and external air temperatures, and on wind speed and direction, in agreement with other published work in the area. The indoor air quality parameters were found to be within acceptable levels when the windcatcher was in operation. The measured air change rate was between 1.5ac/h and 6.8ac/h. Occupants’ questionnaires showed 75 per cent satisfaction with the internal conditions and welcomed the installation of the systems in UK buildings.

A conceptual design of a wireless sensor actuator system for optimising energy and well-being in a building

This article presents a prototype model based on a wireless sensor actuator network (WSAN) aimed at optimizing both energy consumption of environmental systems and well-being of occupants in buildings. The model is a system consisting of the following components: a wireless sensor network, `sense diaries', environmental systems such as heating, ventilation and air-conditioning systems, and a central computer. A multi-agent system (MAS) is used to derive and act on the preferences of the occupants. Each occupant is represented by a personal agent in the MAS. The sense diary is a new device designed to elicit feedback from occupants about their satisfaction with the environment. The roles of the components are: the WSAN collects data about physical parameters such as temperature and humidity from an indoor environment; the central computer processes the collected data; the sense diaries leverage trade-offs between energy consumption and well-being, in conjunction with the agent system; and the environmental systems control the indoor environment.