A quantification of quality of pharmaceutical patient care in hospitals of Houston

The objectives of this study were to evaluate the quality of pharmaceutical services according to the structure and process components of the Donabedian model and to investigate the relationship between these elements. In addition, several factors which might contribute toward the quality of care were investigated to explore their relationships with each of these two quality components. For this study a list of all hospitals in the Houston area was compiled. An interview schedule was prepared for use in personal interviews with the individual in charge of drug distribution in each institution. All inquiries investigated either structure or process components of pharmaceutical patient care and were based on J.C.A.H. accreditation standards and on A.S.H.P. statements. The questions were scored by assigning one point each time the hospitals met these standards. Cumulative scores for each institution were obtained by totaling the number of points in each category. After subjecting the data to statistical analysis, a positive correlation was found between the structure and process components of quality. This relationship is a linear functional one. No correlation was found between the activity of the Pharmacy and Therapeutics Committee and either process or structure scores. Hospitals employing full-time pharmacists have significantly higher components of structure and of process than those employing only consultant pharmacists. Hospitals of 400 beds and over have significantly higher structural components of care than smaller hospitals. Hospitals of 100 beds and over have significantly higher process components than smaller hospitals. Non-profit institutions have significantly higher components of structure and process than profit-making institutions. Government owned hospitals have significantly higher components of structure than non-government, profit-making institutions. No significant difference was found in the structure of non-government, non-profit hospitals and either government owned or non-government, profit-making institutions. Both government owned hospitals and non-government, non-profit hospitals have significantly higher components of process than non-government profit-making insitutions. No significant difference was found in the process variables in government owned hospitals and non-government, non-profit ones. Both structure and process were significantly higher in hospitals employing individuals who have completed a Master's Degree or a residency in hospital pharmacy than in those employing full-time B.S. pharmacy graduates. Both structure and process scores were found to be significantly higher in hospitals utilizing at least one defined "advanced" pharmaceutical service.