Satisfaction with healthcare services among Spanish people with disabilities

BackgroundSeveral studies show the relationship between patient satisfaction and quality of health services and also between disabling conditions and healthcare access, but none sufficiently analyze the factors that contribute to satisfaction among patients with disabilities.Objective/hypothesesThe primary aim of this paper is to quantify the impact of social factors, perceived health status and access on satisfaction with healthcare services among Spanish people with disabilities.MethodsThis paper uses data from the European Health Survey 2009 to construct latent variables related to satisfaction, use and health status among Spanish patients with disabilities. Next, partial least squares path modeling is used for quantifying the effects of certain social factors, service use, and health status on patient satisfaction with received healthcare services.ResultsSatisfaction with healthcare services among people with disabilities is correlated (Nagelkerke R² of 0.175) with certain demographic factors (age, gender and town size), assistance support and patient use of these services. Education level and income were not found to have significant effects.ConclusionsPeople with disabilities generally show a high level of satisfaction with healthcare services, influenced by a positive valuation of the differentiated use given their specific care needs. Subjective aspects of care have a notable influence, linked with the perception of the person's own state of health and emotional status, on these positive valuations; patients' individual perceptions can reduce care needs and the use patients make of healthcare services and tend to increase their level of satisfaction with these services when they do seek them.     

Better Self-report Health Status and Provider–Patient Communication in Dental Service Can Improve the Patient Experience: A Cross-year Comparison from the NHI Survey

ABSTRACT

Several factors, including healthcare outcomes and quality, influence patients’ expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012–2016. This study used the annual NHI survey to explore patients’ experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83–10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients’ experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients     

The Effect of Pay‐for‐Performance in Nursing Homes: Evidence from State Medicaid Programs

Objective

Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting—the implementation of P4P for nursing homes by state Medicaid agencies.

Data Sources/Study Setting

2001–2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets.

Study Design

Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls.

Principal Findings

Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change.

Conclusions

Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered.     

Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction

ObjectiveWe evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn.Study designWe implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ’s effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points.ResultsIn primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69–76%, p = 0.58), but increased patient satisfaction (81–97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction.ConclusionsImplementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling.ImplicationsFurther studies of the impact of clinic-level implementation of OKQ are needed.     

Task shifting in primary care to tackle healthcare worker shortages: An umbrella review

BackgroundTask shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear.ObjectivesTo provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes.MethodsSix electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2.ResultsTwenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing.ConclusionEvidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.     

Exploring the acceptability of the available pneumococcal conjugate vaccines in Canadian health care professionals and immunization experts

BackgroundIn children, the 13 and 10-valent pneumoccocal conjugate vaccines (PCV13/10) are currently approved for the prevention of invasive pneumococcal disease (IPD). Acceptability is a key consideration in the implementation of a vaccine program and it is recognized that health professional’s attitudes and opinions towards vaccines are independent predictors of the success of an immunization program. We aimed to survey the beliefs and attitudes for the two available PCVs in health care professionals and immunization experts.FindingsWe interviewed 21 members of Canadian immunization committees and/or participants working in frontline healthcare delivery. Overall, participants predominantly preferred PCV-13 over PCV10. For most, AOM should not be taken into considerations in decisions for pneumococcal vaccination programs implementation. AOM was considered an important endpoint of the program but an ineffective measure of program success due to the lack of surveillance for the condition. Recent evidence pertaining to PCV10 cross-protection against 19A did not affect preference but had an impact on perceptions regarding pricing.ConclusionTo consider implementing any changes to the current program, most participants would require more evidence regarding PCV10 cross-protection and effectiveness against OM. Decreasing vaccine price was cited as a positive outcome of funding both vaccines.     

Quantitative comparison of measurements of urgent care service quality

ABSTRACT

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.     

Toward System-Wide Implementation of Patient-Reported Outcome Measures: A Framework for Countries,States, and Regions

ObjectivesThis study aimed to develop a framework facilitating (1) the maturity assessment of healthcare systems regarding patient-reported outcome measure (PROM) implementation and (2) the comparison of different healthcare systems’ PROM implementation levels to guide discussions and derive lessons for regional, state-level, and national PROM initiatives.MethodsGuided by the grounded theory methodology, a PROM healthcare system implementation framework was developed following multiple steps. Based on interviews with 28 experts from 12 countries and a literature review, a framework was drafted and refined through 29 additional validation interviews.ResultsThe resulting framework comprises 5 implementation stages along 7 dimensions. Implementation stages range from “first experimentation” to “system-wide adoption and a vibrant ecosystem.” The dimensions are grouped into patient-reported outcome (PRO) measurement and PRO utilization, the former with the dimensions “scope and condition coverage,” “metric and process standardization,” and “tools and information technology–based solutions” and the latter with “patient empowerment and clinical decision support,” “reporting and quality improvement,” and “rewarding and contracting.” The “culture and stakeholder involvement” dimension connects both groups. Although a concerted implementation approach across dimensions can be observed in advanced countries, others show a more uneven adoption.ConclusionsThe framework and its preliminary application to different healthcare systems demonstrate (1) the importance of coherent progress across complementing dimensions and (2) the relevance of PROM integration across clinical specialties and care sectors to strengthen patient-centered care. Overall, the framework can facilitate dialogues between stakeholders to analyze the current PROM implementation status and strategies to advance it.     

Impact of a pay for performance program to improve diabetes care in the safety net

ObjectiveTo evaluate the impact of a “piece-rate” pay for performance (P4P) program aimed at improving diabetes care processes, outcomes and related healthcare utilization for patients enrolled in a not-for-profit Medicaid-focused managed care plan.MethodsTo evaluate Hudson Health Plan's P4P program in New York (2003–2007), we conducted: (1) a case-comparison difference-in-difference study using plan-level administrative data; (2) a patient-level claims data analysis; and (3) a cross-sectional survey.ResultsThe case-comparison study found that diabetes care processes (e.g., HbA1c, lipid, and dilated eye exam rates) and outcomes (e.g., LDL-C < 100 mg/dL) did not improve significantly over the study period. Claims analysis showed that younger adults had significantly increased odds (OR 3.50–3.56, p < 0.001) of using emergency and hospital-based services and similarly decreased odds of receiving recommended care process (OR 0.22–0.36, p < 0.01–0.001). Survey study indicated that practices lack fundamental quality improvement infrastructures and training.ConclusionsRecent health legislation mandates the use of P4P incentives in government programs that disproportionately care for patients with lower socioeconomic or minority backgrounds (e.g., Medicaid, Veterans Health Administration, and Tricare). More research is needed in order to understand how to tailor P4P programs for vulnerable care settings.     

Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network

Purpose

The objective of this study is to present the implementation science approaches that were used before implementing electronic patient-reported outcome measures (ePROMs) across an integrated chronic pain network that includes primary, rehabilitation, and hospital-based care.

Methods

The Theoretical Domains Framework (TDF) was used to identify potential barriers and enablers to the use of ePROMS by primary care clinicians. In rehabilitation and tertiary care, the Consolidated Framework for Implementation (CFIR) was used to guide the identification of determinants of implementations, through observation of workflow, patient and clinician surveys, and clinician interviews. A mixed-method concurrent design comprising a quantitative and qualitative analysis was used. The results were reviewed by a steering committee to iteratively inform the ePROM implementation plan. The Proctor framework of evaluation was used to guide the development of an evaluation plan for the implementation of ePROMs in the integrated chronic pain network.

Results

Both frameworks provided similar results with respect to healthcare provider knowledge, behaviour, and experience interpreting PROM scores. The TDF and CFIR frameworks differed in identifying organizational-level determinants. The resultant implementation plan was structured around the adoption of PROMs to inform individual treatment planning and quality improvement. The evaluation plan focused on implementation and impact outcomes to evaluate the ePROM intervention.

Conclusions

The TDF and CFIR guided the development of a multi-component knowledge translation and training intervention that will address multiple gaps and barriers to implementation of PROMs across the integrated network. The ePROM intervention will aim to increase clinicians’ knowledge and skills and foster best practices.

     

Efficacy of Advance Care Planning: A Systematic Review and Meta-Analysis

ObjectiveTo systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations.DesignSystematic review and meta-analyses.Data SourcesMedline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists.Study SelectionRandomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English.Data Extraction and SynthesisFifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: ‘advance directives’ and ‘communication.’Main Outcomes and MeasuresPrimary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms.ResultsInterventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication.ConclusionsACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.     

Sociotechnical factors of sustainable digital health systems: A system dynamics model

BackgroundThe introduction of digital health technology in a healthcare facility results in emergent and recursive interactions between new technology and existing social systems, technologies, and operating environments.ObjectivesThe study aims at developing a sociotechnical system dynamics model of digital health systems to assess the influence of sociotechnical factors on the sustainable use of an electronic Health Information Management System (eHMIS).MethodsA total of 40 face-to-face interviews in 18 healthcare facilities and two separate sessions of focus group discussions were conducted to study eHMIS implementation in Ethiopia. A system dynamics modelling of digital health systems implementation is developed, tested and verified with a case of eHMIS implementation in Ethiopia.ResultsThe long-term sustainability of the digital health system requires acceptance of technology, improved information quality to make appropriate decisions and better end-user satisfaction. The ‘individuals’ intention to use’ drives technology acceptance in the early years of the eHMIS use and social factors in the later stage. Besides, the role of technology to improve work performance determines the level of users’ satisfaction. The effort of improving ‘information quality’ is strongly influenced by the quality systems, i.e., reliable, easy to use, and capable to meet end-user requirements.ConclusionsThe system's acceptance was improved through effective training and communication, whereas the ‘information quality’ was enhanced through ‘system quality’ and users’ satisfaction. The ability of technology to improve work performance and reduce the burden on end-users has increased the satisfaction of end-users.     

Comparación de la satisfacción de los usuarios de atención domiciliaria: modelo integrado vs. modelo dispensarizado

ObjectiveTo determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model.Designcross-sectional, observational study.LocationTwo primary care centers in the province of Barcelona.ParticipantsThe questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model.Main measurementsThe Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc).ResultsThe patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception,or independence of theConclusionsThe user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions.     

Kardiologische Betreuungsmodelle

Background

The demographic shift and the ever more difficult challenge of financing the German healthcare system have led to fundamental changes in all sectors of medical care. By looking in detail at the field of cardiology, current tendencies and developments in medical care will be analysed and their strengths and weaknesses depicted.

Methods

The overview analyses both traditional and new concepts of cardiology and focuses on the points of contact and distinctive methodical features.

Results

The main ambition of the disease management programme for coronary heath disease is to improve quality of care. By now, encouraging first results concerning the improvement of morbidity, the efficient management of risk factors, and an increased adherence to therapy according to guidelines can be reported. The biggest challenge for health insurance on the one hand and physicians and hospitals on the other is the implementation of concepts of integrated care (in German: Integrierte Versorgung, IV). Not only do these concepts question the separation between ambulant and stationary care, but they also have a general impact on the regulations regarding financing of the healthcare system. Despite these challenges, integrated care does have a positive effect in terms of introducing new, innovative methods and treatment concepts (e.g. the possibility of a fast coronary intervention after acute coronary syndrome, regardless of the patient’s location).

Conclusion

New and innovative structures for medical care hold great opportunities for improvements in treating cardiac patients. However, these new structures need scientific analysis so that their effects on quality of care and cost efficiency can be determined.     

Adaptation and qualitative evaluation of Ask 3 Questions — a simple and generic intervention to foster patient empowerment

BackgroundPatients are often not actively engaged in medical encounters. Short interventions like Ask 3 Questions (Ask3Q) can increase patient participation in decision‐making. Up to now, Ask3Q was not available in German.ObjectiveTo translate Ask3Q and evaluate its acceptability and feasibility.MethodsWe translated and adapted several English versions of Ask3Q using a team translation protocol and cognitive interviews. Acceptability and feasibility of the final German Ask3Q version were assessed via focus groups and interviews with patients and healthcare professionals (HCPs). Data were analysed via qualitative content analysis.ResultsTranslation and adaptation were successful. Participants of focus groups and interviews perceived Ask3Q as a tool to empower patients to ask more questions. Moreover, it was seen as a guideline for physicians not to forget conveying important information. Several characteristics of patients, HCPs, the clinical setting and the intervention were identified as facilitators and barriers for an effective implementation of Ask3Q.ConclusionWe provide the German version of Ask3Q. According to participants, implementation of Ask3Q in the German healthcare system is feasible. Future studies should evaluate if positive effects of Ask3Q can be replicated for patient participation and communication behaviour of HCPs in Germany.     

Implementing a Hospitalist Program in a Critical Access Hospital

Purpose

The hospitalist model of inpatient care has rapidly expanded, but little is known about hospitalist care in critical access hospitals (CAHs). We aimed to determine the impact of a hospitalist model of care on staff satisfaction, patient volumes, patient satisfaction, length of stay, and care quality in a CAH.

Methods

We initiated a hybrid rotating hospitalist program in September 2008 at Winneshiek Medical Center (Decorah, Iowa), a 25‐bed rural CAH. We reviewed patient volumes, Centers for Medicare and Medicaid Services core quality measures, acute length of stay, and staff satisfaction for primary care—hospitalist physicians and inpatient and clinic nurses. Patient volume and length of stay were compared with CAH data reported by the Iowa Hospital Association.

Findings

Patient volumes (acute, skilled, and observation) increased by 15% compared with a 17% decrease for statewide CAHs. Length of stay decreased from 2.88 to 2.75 days and remained lower than the average stay for Iowa CAHs (3.05 days). In the year after implementation, we observed no deterioration in core quality measures (range, 93%‐100%) or patient satisfaction (86th percentile). Inpatient nurse satisfaction and primary care‐hospitalist satisfaction improved. Early clinic nurse skepticism showed improved satisfaction at the 5‐year review.

Conclusions

Hospitalist care contributed to ongoing delivery of high‐quality care and satisfactory patient experiences while supporting the mission of a CAH in rural Iowa. Implementation required careful consideration of its effects on the outpatient practice. Broader implementation of this model in CAHs may be warranted.     

Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care

BACKGROUND: A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams. OBJECTIVE: To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction. METHODS: Before-after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002-2003. QPL and end-user satisfaction were used as outcome measures. RESULTS: QPL was improved in terms of the dimension "perception of support from the management structure" among physicians (4.897 versus 5.220; p<0.001) as well as nurses (5.272 versus 5.638; p<0.001). Further, physicians perceived an increase in the dimension "demands made upon them" (6.124 versus 6.364; p<0.001), differently from the nurses group (5.8191 versus 5.929; p=0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses (beta=0.078, p=0.007), and a negative relationship between "demands made upon them" and user satisfaction in the case of physicians (beta=-0.057, p=0.011). CONCLUSIONS: Incentives related to quality of care annual targets may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase in professionals' perception of support from the management structure. Among nurses, this increase is related to an improvement of user satisfaction.     

Factors associated with professional satisfaction in primary care: Results from EUprimecare project

Background: Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine.

Objectives: This study explored factors associated with professional satisfaction in seven European countries.

Methods: A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians.

Results: A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR?=?1.01), integrated network of primary care centres (OR?=?2.8), patients having direct access to specialists (OR?=?1.3) and professionals having access to data on patient satisfaction (OR?=?1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR?=?0.8).

Conclusion: Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.     

Integration of Smartphones into clinical pharmacy practice: An evaluation of the impact on pharmacists׳ efficiency

BackgroundPersonal smartphones are used frequently by healthcare practitioners in hospitals to assist in the provision of care. Island Health is one of the first health authorities in Canada to endorse the iPhone^®smartphone as a potentially valuable tool for clinical practice.ObjectiveTo measure smartphones effect on pharmacists׳ efficiency, to assess pharmacist acceptance of corporate smartphones, and to investigate how these devices are being utilized.MethodsThis multi-center time-trial, survey, and observational prospective study enrolled 90 pharmacists across eight hospitals on Vancouver Island. Participants performed a time-trial of 22 situational drug information questions before and after receiving an iPhone^®. They also completed demographic and satisfaction surveys. A subset of 14 of the 90 pharmacists participated in a pre- and post- iPhone^® implementation eight hour direct observation study. Lastly, communication data from the phone service provider was collected and analyzed.ResultsSmartphone use was associated with a faster median response time of approximately six minutes for all situational time-trial questions combined (48 min:15 s pre-iPhone^® vs. 42 min:18 s post-iPhone^®) (p=0.039). Smartphone use did not significantly influence time spent walking to obtain a resource, time spent using computers, or time spent answering of clinical questions during observation. Almost half of pharmacists reported that using the smartphone increased their confidence and competence to resolve drug therapy problems.ConclusionsPharmacists readily accepted smartphones into their practice and felt positively about using them. Smartphones did not improve direct observation measures of workflow, but they did improve pharmacists׳ efficiency in the answering of hypothetical drug information questions (p=0.039). This study indicates that if smartphones are incorporated into pharmacy practice in a structured, organized manner with supports and training in place, smartphone uptake will occur and pharmacists will adapt and incorporate this technology into their daily routine with no predicted deterioration in the quality of their work. The impact of improved efficiency on patient care resulting from an increased reliance on technology and time spent on devices needs to be further assessed.