Instruments to measure patient satisfaction with comprehensive medication management (CMM) services: a scoping review

General characteristics of the included studies.

Author (year)	Country	Instrument name—abbreviation	Objective	Context	Term used for service
Development and validation studies of a patient satisfaction measurement instrument
Armando et al. [21] (2012)	Spain	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	To develop and validate an instrument to assess patient satisfaction with pharmaceutical care services	Adult patients or caregivers from community pharmacies who received the service	Pharmaceutical care
Armando, Uema and Solá [22] (2005)	Argentina	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	To assess patient satisfaction with pharmacotherapy follow-up	Adult patients or caregivers who received the service at the College of Pharmacists of the Province of Cordoba	Pharmacotherapy follow-up
Gourley et al. [23] (1998)	EUA	Pharmaceutical care questionnaire—PCQ	To evaluate the humanistic outcomes of a pharmaceutical care service	Adult patients with hypertension or chronic obstructive pulmonary disease who received the service	Pharmaceutical care
Kassam, Collins and Berkowitz [24] (2009)	Canada	Satisfaction survey	To evaluate the patient satisfaction with pharmaceutical care services.	Asthma patients who received the service at community pharmacies	Pharmaceutical care
Larson et al. [25] (2002)	EUA	Pharmacy services questionnaire—PSQ	To develop a questionnaire for measuring patient satisfaction with pharmaceutical care and to establish its dimensional structure	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Lyra Júnior et al. [26] (2005)	Brazil	Undefined	To define a socio-demographic profile of a group of older patients to implement pharmaceutical care; to analyse the outcomes of pharmacist interventions; and to assess patient satisfaction	Older patients with hypertension who received the service	Pharmaceutical care
Moczygemba et al. [27] (2010)	EUA	Patient satisfaction survey	To measure patient satisfaction with a telephone medication therapy management program	Adult patients who received telephone service consultation provided by Scott & White Health Plan part D.	medication therapy management
Monje-Agudo et al. [28] (2015)	Spain	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	To design and validate a questionnaire to assess patient satisfaction with pharmaceutical care	Outpatients from five hospitals who received the service	Pharmaceutical care
Moon et al. [15] (2016)	EUA	Patient satisfaction survey	To develop a psychometrically valid questionnaire for measuring patient satisfaction with comprehensive medication management services	Adult patients from the health-systems alliance for intergrade medication management who received the service	Comprehensive medication management
Translation and validation studies
Correr et al. [29] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To translate and validate the instrument developed by Larson et al. [25] into Brazilian Portuguese	Adult patients with type 2 diabetes, clinical trial participants from Federal University of Paraná, Brazil	Pharmaceutical services
Iglésias et al. [30] (2005)	Portugal	Pharmacy services questionnaire (Questionário sobre os Serviços da Farmácia)	To obtain one validated instrument in Portuguese (European) from the instrument developed by Larson et al. [25].	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Kanovsky et al. [31] (2017)	Slovak Republic	Undefined	To perform a robust validation of a patient satisfaction instrument previously developed by Larson et al. [25].	Customers from community pharmacies in Slovak who did not receive the service	Pharmaceutical care
Quispe et al. [32] (2011)	Spain	Patient satisfaction questionnaire—PSQ	To carry out a cross-cultural adaptation, to describe and assess the psychometric properties of a patient satisfaction questionnaire developed by Traverso et al [55].	Adult patients from community pharmacies in Spain who did not receive the service	Pharmaceutical care
Studies that applied a previously validated instrument to measure satisfaction
Andrade et al. [33] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To evaluate patient satisfaction with a pharmaceutical care service provided in a private community pharmacy using the instrument developed by Correr et al. [29]	Adult patients from a private communitarian pharmacy who received the service	Pharmaceutical care
Dantas [34] (2007)	Brazil	Undefined	To describe the humanistic and clinical outcomes of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26] to measure patient satisfaction	Asthma patients who received the service	Pharmaceutical care
Dewulf [35] (2010)	Brazil	Undefined	To assess the contribution of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26]	Adult patients with inflammatory bowel diseases who received the service at a reference hospital	Pharmaceutical care
Foppa [36] (2014)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To identify the managerial, humanistic, and clinical elements necessary to qualify a clinical pharmaceutical service using the instrument developed by Correr et al. [29]	Adult patients with Parkinson’s disease or caregivers who received the service	Pharmacotherapy follow-up
Penaforte [37] (2011)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To implement a pharmaceutical care model, evaluating its clinical, economic and social impact using the instrument developed by Correr et al. [29].	Adult patients with hypertension who received the service	Pharmaceutical care
Reis [38] (2018)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To analyse the clinical and humanistic outcomes of medication therapy management services using the instrument developed by Correr et al [29]	Renal transplant patients who received the service	Medication therapy management
Non-validated informal measurements of patient satisfaction
Garcia-Cardenas et al. [39] (2017)	Spain	Undefined	To describe the implementation process of a medication review service with follow-up provided in a community pharmacy setting and to evaluate its outcomes	Adult patients from community pharmacies who received the service	Medication review with follow-up
Hasen and Negeso [40] (2021)	Ethiopia	Undefined	To determine patient satisfaction with a pharmaceutical care service and associated factors	Adult patients admitted to medical wards in Jimma University Medical Centre who received the service	Pharmaceutical care
Kim et al. [41] (2016)	EUA	Survey instrument	To assess patient satisfaction with pharmacists and pharmacy services	Adult patients who received the service at the University Illinois Hospital and Health Sciences	Medication therapy management
Lam [42] (2011)	EUA	Patient satisfaction survey	To describe medication therapy management services via videoconference	Adult patients with diabetes, hypertension, hyperlipidemia, asthma/chronic obstructive pulmonary disease, multiple sclerosis, or Parkinson’s disease who received the service via videoconference	Medication therapy management
Parsons and Zimmermann [43] (2019)	EUA	Satisfaction survey	To describe and evaluate a novel practice setting for pharmacists within an occupational health clinic, and to evaluate the impact on patient care	Adult patients with any chronic disease, elevate biometric results or medication questions who received the service at an occupational health clinic of a large company	Comprehensive medication management
Ramalho de Oliveira et al. [44] (2010)	EUA	Patient satisfaction survey	To present the clinical, economic, and humanistic outcomes of medication therapy management services	Adult patients eligible for medication therapy management services in a health care delivery system over 10 years	Medication therapy management
Volume et al. [45] (2001)	Canada	Undefined	To describe changes in patients’ adherence to therapy, expectations and satisfaction with pharmacy services, and health-related quality of life after the provision of pharmaceutical care	Older patients use three or more medications covered under Alberta Health & Wellness’s senior drug benefit plan	Pharmaceutical care
Yeoh et al. [46] (2013)	Singapore	Patient satisfaction survey—PSS	To identify common drug-related problems among older cancer patients; to determine the effectiveness of Medication Therapy Management services, the clinical significance of pharmacist interventions, and patient satisfaction	Elderly cancer patients with at least one chronic medication who received the service	Medication therapy management
Psychometric evaluation study of a previously validated instrument
Campbell et al. [47] (2022)	EUA	Patient satisfaction survey	To assess the psychometric properties and factor structure of the instrument developed by Moon et al. [15].	Adult patients from the health-systems alliance for Intergrade Medication Management who received the service	Comprehensive medication management

Author (year)	Country	Instrument name—abbreviation	Objective	Context	Term used for service
Development and validation studies of a patient satisfaction measurement instrument
Armando et al. [21] (2012)	Spain	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	To develop and validate an instrument to assess patient satisfaction with pharmaceutical care services	Adult patients or caregivers from community pharmacies who received the service	Pharmaceutical care
Armando, Uema and Solá [22] (2005)	Argentina	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	To assess patient satisfaction with pharmacotherapy follow-up	Adult patients or caregivers who received the service at the College of Pharmacists of the Province of Cordoba	Pharmacotherapy follow-up
Gourley et al. [23] (1998)	EUA	Pharmaceutical care questionnaire—PCQ	To evaluate the humanistic outcomes of a pharmaceutical care service	Adult patients with hypertension or chronic obstructive pulmonary disease who received the service	Pharmaceutical care
Kassam, Collins and Berkowitz [24] (2009)	Canada	Satisfaction survey	To evaluate the patient satisfaction with pharmaceutical care services.	Asthma patients who received the service at community pharmacies	Pharmaceutical care
Larson et al. [25] (2002)	EUA	Pharmacy services questionnaire—PSQ	To develop a questionnaire for measuring patient satisfaction with pharmaceutical care and to establish its dimensional structure	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Lyra Júnior et al. [26] (2005)	Brazil	Undefined	To define a socio-demographic profile of a group of older patients to implement pharmaceutical care; to analyse the outcomes of pharmacist interventions; and to assess patient satisfaction	Older patients with hypertension who received the service	Pharmaceutical care
Moczygemba et al. [27] (2010)	EUA	Patient satisfaction survey	To measure patient satisfaction with a telephone medication therapy management program	Adult patients who received telephone service consultation provided by Scott & White Health Plan part D.	medication therapy management
Monje-Agudo et al. [28] (2015)	Spain	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	To design and validate a questionnaire to assess patient satisfaction with pharmaceutical care	Outpatients from five hospitals who received the service	Pharmaceutical care
Moon et al. [15] (2016)	EUA	Patient satisfaction survey	To develop a psychometrically valid questionnaire for measuring patient satisfaction with comprehensive medication management services	Adult patients from the health-systems alliance for intergrade medication management who received the service	Comprehensive medication management
Translation and validation studies
Correr et al. [29] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To translate and validate the instrument developed by Larson et al. [25] into Brazilian Portuguese	Adult patients with type 2 diabetes, clinical trial participants from Federal University of Paraná, Brazil	Pharmaceutical services
Iglésias et al. [30] (2005)	Portugal	Pharmacy services questionnaire (Questionário sobre os Serviços da Farmácia)	To obtain one validated instrument in Portuguese (European) from the instrument developed by Larson et al. [25].	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Kanovsky et al. [31] (2017)	Slovak Republic	Undefined	To perform a robust validation of a patient satisfaction instrument previously developed by Larson et al. [25].	Customers from community pharmacies in Slovak who did not receive the service	Pharmaceutical care
Quispe et al. [32] (2011)	Spain	Patient satisfaction questionnaire—PSQ	To carry out a cross-cultural adaptation, to describe and assess the psychometric properties of a patient satisfaction questionnaire developed by Traverso et al [55].	Adult patients from community pharmacies in Spain who did not receive the service	Pharmaceutical care
Studies that applied a previously validated instrument to measure satisfaction
Andrade et al. [33] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To evaluate patient satisfaction with a pharmaceutical care service provided in a private community pharmacy using the instrument developed by Correr et al. [29]	Adult patients from a private communitarian pharmacy who received the service	Pharmaceutical care
Dantas [34] (2007)	Brazil	Undefined	To describe the humanistic and clinical outcomes of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26] to measure patient satisfaction	Asthma patients who received the service	Pharmaceutical care
Dewulf [35] (2010)	Brazil	Undefined	To assess the contribution of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26]	Adult patients with inflammatory bowel diseases who received the service at a reference hospital	Pharmaceutical care
Foppa [36] (2014)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To identify the managerial, humanistic, and clinical elements necessary to qualify a clinical pharmaceutical service using the instrument developed by Correr et al. [29]	Adult patients with Parkinson’s disease or caregivers who received the service	Pharmacotherapy follow-up
Penaforte [37] (2011)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To implement a pharmaceutical care model, evaluating its clinical, economic and social impact using the instrument developed by Correr et al. [29].	Adult patients with hypertension who received the service	Pharmaceutical care
Reis [38] (2018)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To analyse the clinical and humanistic outcomes of medication therapy management services using the instrument developed by Correr et al [29]	Renal transplant patients who received the service	Medication therapy management
Non-validated informal measurements of patient satisfaction
Garcia-Cardenas et al. [39] (2017)	Spain	Undefined	To describe the implementation process of a medication review service with follow-up provided in a community pharmacy setting and to evaluate its outcomes	Adult patients from community pharmacies who received the service	Medication review with follow-up
Hasen and Negeso [40] (2021)	Ethiopia	Undefined	To determine patient satisfaction with a pharmaceutical care service and associated factors	Adult patients admitted to medical wards in Jimma University Medical Centre who received the service	Pharmaceutical care
Kim et al. [41] (2016)	EUA	Survey instrument	To assess patient satisfaction with pharmacists and pharmacy services	Adult patients who received the service at the University Illinois Hospital and Health Sciences	Medication therapy management
Lam [42] (2011)	EUA	Patient satisfaction survey	To describe medication therapy management services via videoconference	Adult patients with diabetes, hypertension, hyperlipidemia, asthma/chronic obstructive pulmonary disease, multiple sclerosis, or Parkinson’s disease who received the service via videoconference	Medication therapy management
Parsons and Zimmermann [43] (2019)	EUA	Satisfaction survey	To describe and evaluate a novel practice setting for pharmacists within an occupational health clinic, and to evaluate the impact on patient care	Adult patients with any chronic disease, elevate biometric results or medication questions who received the service at an occupational health clinic of a large company	Comprehensive medication management
Ramalho de Oliveira et al. [44] (2010)	EUA	Patient satisfaction survey	To present the clinical, economic, and humanistic outcomes of medication therapy management services	Adult patients eligible for medication therapy management services in a health care delivery system over 10 years	Medication therapy management
Volume et al. [45] (2001)	Canada	Undefined	To describe changes in patients’ adherence to therapy, expectations and satisfaction with pharmacy services, and health-related quality of life after the provision of pharmaceutical care	Older patients use three or more medications covered under Alberta Health & Wellness’s senior drug benefit plan	Pharmaceutical care
Yeoh et al. [46] (2013)	Singapore	Patient satisfaction survey—PSS	To identify common drug-related problems among older cancer patients; to determine the effectiveness of Medication Therapy Management services, the clinical significance of pharmacist interventions, and patient satisfaction	Elderly cancer patients with at least one chronic medication who received the service	Medication therapy management
Psychometric evaluation study of a previously validated instrument
Campbell et al. [47] (2022)	EUA	Patient satisfaction survey	To assess the psychometric properties and factor structure of the instrument developed by Moon et al. [15].	Adult patients from the health-systems alliance for Intergrade Medication Management who received the service	Comprehensive medication management

Table 1.

General characteristics of the included studies.

Author (year)	Country	Instrument name—abbreviation	Objective	Context	Term used for service
Development and validation studies of a patient satisfaction measurement instrument
Armando et al. [21] (2012)	Spain	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	To develop and validate an instrument to assess patient satisfaction with pharmaceutical care services	Adult patients or caregivers from community pharmacies who received the service	Pharmaceutical care
Armando, Uema and Solá [22] (2005)	Argentina	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	To assess patient satisfaction with pharmacotherapy follow-up	Adult patients or caregivers who received the service at the College of Pharmacists of the Province of Cordoba	Pharmacotherapy follow-up
Gourley et al. [23] (1998)	EUA	Pharmaceutical care questionnaire—PCQ	To evaluate the humanistic outcomes of a pharmaceutical care service	Adult patients with hypertension or chronic obstructive pulmonary disease who received the service	Pharmaceutical care
Kassam, Collins and Berkowitz [24] (2009)	Canada	Satisfaction survey	To evaluate the patient satisfaction with pharmaceutical care services.	Asthma patients who received the service at community pharmacies	Pharmaceutical care
Larson et al. [25] (2002)	EUA	Pharmacy services questionnaire—PSQ	To develop a questionnaire for measuring patient satisfaction with pharmaceutical care and to establish its dimensional structure	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Lyra Júnior et al. [26] (2005)	Brazil	Undefined	To define a socio-demographic profile of a group of older patients to implement pharmaceutical care; to analyse the outcomes of pharmacist interventions; and to assess patient satisfaction	Older patients with hypertension who received the service	Pharmaceutical care
Moczygemba et al. [27] (2010)	EUA	Patient satisfaction survey	To measure patient satisfaction with a telephone medication therapy management program	Adult patients who received telephone service consultation provided by Scott & White Health Plan part D.	medication therapy management
Monje-Agudo et al. [28] (2015)	Spain	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	To design and validate a questionnaire to assess patient satisfaction with pharmaceutical care	Outpatients from five hospitals who received the service	Pharmaceutical care
Moon et al. [15] (2016)	EUA	Patient satisfaction survey	To develop a psychometrically valid questionnaire for measuring patient satisfaction with comprehensive medication management services	Adult patients from the health-systems alliance for intergrade medication management who received the service	Comprehensive medication management
Translation and validation studies
Correr et al. [29] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To translate and validate the instrument developed by Larson et al. [25] into Brazilian Portuguese	Adult patients with type 2 diabetes, clinical trial participants from Federal University of Paraná, Brazil	Pharmaceutical services
Iglésias et al. [30] (2005)	Portugal	Pharmacy services questionnaire (Questionário sobre os Serviços da Farmácia)	To obtain one validated instrument in Portuguese (European) from the instrument developed by Larson et al. [25].	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Kanovsky et al. [31] (2017)	Slovak Republic	Undefined	To perform a robust validation of a patient satisfaction instrument previously developed by Larson et al. [25].	Customers from community pharmacies in Slovak who did not receive the service	Pharmaceutical care
Quispe et al. [32] (2011)	Spain	Patient satisfaction questionnaire—PSQ	To carry out a cross-cultural adaptation, to describe and assess the psychometric properties of a patient satisfaction questionnaire developed by Traverso et al [55].	Adult patients from community pharmacies in Spain who did not receive the service	Pharmaceutical care
Studies that applied a previously validated instrument to measure satisfaction
Andrade et al. [33] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To evaluate patient satisfaction with a pharmaceutical care service provided in a private community pharmacy using the instrument developed by Correr et al. [29]	Adult patients from a private communitarian pharmacy who received the service	Pharmaceutical care
Dantas [34] (2007)	Brazil	Undefined	To describe the humanistic and clinical outcomes of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26] to measure patient satisfaction	Asthma patients who received the service	Pharmaceutical care
Dewulf [35] (2010)	Brazil	Undefined	To assess the contribution of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26]	Adult patients with inflammatory bowel diseases who received the service at a reference hospital	Pharmaceutical care
Foppa [36] (2014)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To identify the managerial, humanistic, and clinical elements necessary to qualify a clinical pharmaceutical service using the instrument developed by Correr et al. [29]	Adult patients with Parkinson’s disease or caregivers who received the service	Pharmacotherapy follow-up
Penaforte [37] (2011)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To implement a pharmaceutical care model, evaluating its clinical, economic and social impact using the instrument developed by Correr et al. [29].	Adult patients with hypertension who received the service	Pharmaceutical care
Reis [38] (2018)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To analyse the clinical and humanistic outcomes of medication therapy management services using the instrument developed by Correr et al [29]	Renal transplant patients who received the service	Medication therapy management
Non-validated informal measurements of patient satisfaction
Garcia-Cardenas et al. [39] (2017)	Spain	Undefined	To describe the implementation process of a medication review service with follow-up provided in a community pharmacy setting and to evaluate its outcomes	Adult patients from community pharmacies who received the service	Medication review with follow-up
Hasen and Negeso [40] (2021)	Ethiopia	Undefined	To determine patient satisfaction with a pharmaceutical care service and associated factors	Adult patients admitted to medical wards in Jimma University Medical Centre who received the service	Pharmaceutical care
Kim et al. [41] (2016)	EUA	Survey instrument	To assess patient satisfaction with pharmacists and pharmacy services	Adult patients who received the service at the University Illinois Hospital and Health Sciences	Medication therapy management
Lam [42] (2011)	EUA	Patient satisfaction survey	To describe medication therapy management services via videoconference	Adult patients with diabetes, hypertension, hyperlipidemia, asthma/chronic obstructive pulmonary disease, multiple sclerosis, or Parkinson’s disease who received the service via videoconference	Medication therapy management
Parsons and Zimmermann [43] (2019)	EUA	Satisfaction survey	To describe and evaluate a novel practice setting for pharmacists within an occupational health clinic, and to evaluate the impact on patient care	Adult patients with any chronic disease, elevate biometric results or medication questions who received the service at an occupational health clinic of a large company	Comprehensive medication management
Ramalho de Oliveira et al. [44] (2010)	EUA	Patient satisfaction survey	To present the clinical, economic, and humanistic outcomes of medication therapy management services	Adult patients eligible for medication therapy management services in a health care delivery system over 10 years	Medication therapy management
Volume et al. [45] (2001)	Canada	Undefined	To describe changes in patients’ adherence to therapy, expectations and satisfaction with pharmacy services, and health-related quality of life after the provision of pharmaceutical care	Older patients use three or more medications covered under Alberta Health & Wellness’s senior drug benefit plan	Pharmaceutical care
Yeoh et al. [46] (2013)	Singapore	Patient satisfaction survey—PSS	To identify common drug-related problems among older cancer patients; to determine the effectiveness of Medication Therapy Management services, the clinical significance of pharmacist interventions, and patient satisfaction	Elderly cancer patients with at least one chronic medication who received the service	Medication therapy management
Psychometric evaluation study of a previously validated instrument
Campbell et al. [47] (2022)	EUA	Patient satisfaction survey	To assess the psychometric properties and factor structure of the instrument developed by Moon et al. [15].	Adult patients from the health-systems alliance for Intergrade Medication Management who received the service	Comprehensive medication management

Author (year)	Country	Instrument name—abbreviation	Objective	Context	Term used for service
Development and validation studies of a patient satisfaction measurement instrument
Armando et al. [21] (2012)	Spain	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	To develop and validate an instrument to assess patient satisfaction with pharmaceutical care services	Adult patients or caregivers from community pharmacies who received the service	Pharmaceutical care
Armando, Uema and Solá [22] (2005)	Argentina	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	To assess patient satisfaction with pharmacotherapy follow-up	Adult patients or caregivers who received the service at the College of Pharmacists of the Province of Cordoba	Pharmacotherapy follow-up
Gourley et al. [23] (1998)	EUA	Pharmaceutical care questionnaire—PCQ	To evaluate the humanistic outcomes of a pharmaceutical care service	Adult patients with hypertension or chronic obstructive pulmonary disease who received the service	Pharmaceutical care
Kassam, Collins and Berkowitz [24] (2009)	Canada	Satisfaction survey	To evaluate the patient satisfaction with pharmaceutical care services.	Asthma patients who received the service at community pharmacies	Pharmaceutical care
Larson et al. [25] (2002)	EUA	Pharmacy services questionnaire—PSQ	To develop a questionnaire for measuring patient satisfaction with pharmaceutical care and to establish its dimensional structure	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Lyra Júnior et al. [26] (2005)	Brazil	Undefined	To define a socio-demographic profile of a group of older patients to implement pharmaceutical care; to analyse the outcomes of pharmacist interventions; and to assess patient satisfaction	Older patients with hypertension who received the service	Pharmaceutical care
Moczygemba et al. [27] (2010)	EUA	Patient satisfaction survey	To measure patient satisfaction with a telephone medication therapy management program	Adult patients who received telephone service consultation provided by Scott & White Health Plan part D.	medication therapy management
Monje-Agudo et al. [28] (2015)	Spain	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	To design and validate a questionnaire to assess patient satisfaction with pharmaceutical care	Outpatients from five hospitals who received the service	Pharmaceutical care
Moon et al. [15] (2016)	EUA	Patient satisfaction survey	To develop a psychometrically valid questionnaire for measuring patient satisfaction with comprehensive medication management services	Adult patients from the health-systems alliance for intergrade medication management who received the service	Comprehensive medication management
Translation and validation studies
Correr et al. [29] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To translate and validate the instrument developed by Larson et al. [25] into Brazilian Portuguese	Adult patients with type 2 diabetes, clinical trial participants from Federal University of Paraná, Brazil	Pharmaceutical services
Iglésias et al. [30] (2005)	Portugal	Pharmacy services questionnaire (Questionário sobre os Serviços da Farmácia)	To obtain one validated instrument in Portuguese (European) from the instrument developed by Larson et al. [25].	Adult patients from community pharmacies who did not receive the service	Pharmaceutical care
Kanovsky et al. [31] (2017)	Slovak Republic	Undefined	To perform a robust validation of a patient satisfaction instrument previously developed by Larson et al. [25].	Customers from community pharmacies in Slovak who did not receive the service	Pharmaceutical care
Quispe et al. [32] (2011)	Spain	Patient satisfaction questionnaire—PSQ	To carry out a cross-cultural adaptation, to describe and assess the psychometric properties of a patient satisfaction questionnaire developed by Traverso et al [55].	Adult patients from community pharmacies in Spain who did not receive the service	Pharmaceutical care
Studies that applied a previously validated instrument to measure satisfaction
Andrade et al. [33] (2009)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To evaluate patient satisfaction with a pharmaceutical care service provided in a private community pharmacy using the instrument developed by Correr et al. [29]	Adult patients from a private communitarian pharmacy who received the service	Pharmaceutical care
Dantas [34] (2007)	Brazil	Undefined	To describe the humanistic and clinical outcomes of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26] to measure patient satisfaction	Asthma patients who received the service	Pharmaceutical care
Dewulf [35] (2010)	Brazil	Undefined	To assess the contribution of a pharmaceutical care service using the instrument developed by Lyra Júnior et al. [26]	Adult patients with inflammatory bowel diseases who received the service at a reference hospital	Pharmaceutical care
Foppa [36] (2014)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To identify the managerial, humanistic, and clinical elements necessary to qualify a clinical pharmaceutical service using the instrument developed by Correr et al. [29]	Adult patients with Parkinson’s disease or caregivers who received the service	Pharmacotherapy follow-up
Penaforte [37] (2011)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To implement a pharmaceutical care model, evaluating its clinical, economic and social impact using the instrument developed by Correr et al. [29].	Adult patients with hypertension who received the service	Pharmaceutical care
Reis [38] (2018)	Brazil	Pharmacy services questionnaire (Questionário de Satisfação com Serviços da Farmácia - QSSF)	To analyse the clinical and humanistic outcomes of medication therapy management services using the instrument developed by Correr et al [29]	Renal transplant patients who received the service	Medication therapy management
Non-validated informal measurements of patient satisfaction
Garcia-Cardenas et al. [39] (2017)	Spain	Undefined	To describe the implementation process of a medication review service with follow-up provided in a community pharmacy setting and to evaluate its outcomes	Adult patients from community pharmacies who received the service	Medication review with follow-up
Hasen and Negeso [40] (2021)	Ethiopia	Undefined	To determine patient satisfaction with a pharmaceutical care service and associated factors	Adult patients admitted to medical wards in Jimma University Medical Centre who received the service	Pharmaceutical care
Kim et al. [41] (2016)	EUA	Survey instrument	To assess patient satisfaction with pharmacists and pharmacy services	Adult patients who received the service at the University Illinois Hospital and Health Sciences	Medication therapy management
Lam [42] (2011)	EUA	Patient satisfaction survey	To describe medication therapy management services via videoconference	Adult patients with diabetes, hypertension, hyperlipidemia, asthma/chronic obstructive pulmonary disease, multiple sclerosis, or Parkinson’s disease who received the service via videoconference	Medication therapy management
Parsons and Zimmermann [43] (2019)	EUA	Satisfaction survey	To describe and evaluate a novel practice setting for pharmacists within an occupational health clinic, and to evaluate the impact on patient care	Adult patients with any chronic disease, elevate biometric results or medication questions who received the service at an occupational health clinic of a large company	Comprehensive medication management
Ramalho de Oliveira et al. [44] (2010)	EUA	Patient satisfaction survey	To present the clinical, economic, and humanistic outcomes of medication therapy management services	Adult patients eligible for medication therapy management services in a health care delivery system over 10 years	Medication therapy management
Volume et al. [45] (2001)	Canada	Undefined	To describe changes in patients’ adherence to therapy, expectations and satisfaction with pharmacy services, and health-related quality of life after the provision of pharmaceutical care	Older patients use three or more medications covered under Alberta Health & Wellness’s senior drug benefit plan	Pharmaceutical care
Yeoh et al. [46] (2013)	Singapore	Patient satisfaction survey—PSS	To identify common drug-related problems among older cancer patients; to determine the effectiveness of Medication Therapy Management services, the clinical significance of pharmacist interventions, and patient satisfaction	Elderly cancer patients with at least one chronic medication who received the service	Medication therapy management
Psychometric evaluation study of a previously validated instrument
Campbell et al. [47] (2022)	EUA	Patient satisfaction survey	To assess the psychometric properties and factor structure of the instrument developed by Moon et al. [15].	Adult patients from the health-systems alliance for Intergrade Medication Management who received the service	Comprehensive medication management

Instrument characteristics and evaluation score on the Francis checklist

Among the 28 selected studies, nine (32.1%) [15, 21–28] used original and validated instruments. The characteristics of these studies that used an original and validated instrument are described in Table 2. It is noteworthy that most studies (n = 17; 60.7%) [15, 21–25, 27, 28, 39–47], used instruments developed by the authors themselves, and 11 (39.3%) [29–38, 47] used instruments developed by other authors or their translation and adaptation.

Table 2.

Characteristics of the original validated instruments to measure patient satisfaction with CMM services.

Author (year)	Name of instrument—abbreviations	Language	Construct definition	How is the administration?	Type of questions (number of questions)	Number of respondents
Armando et al. [21] (2012)	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	Spanish	Satisfaction is defined as a reflection of the provider’s ability to meet the needs of patients	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	103
Armandoet al. [22] (2005)	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	Spanish	Satisfaction is defined as a humanistic outcome of approving quality of care and reflects the provider’s ability to meet patients’ needs	Self-administered printed instrument	dichotomic (6)^*; Likert-scale 1–4 (5); open-ended (1)	40
Gourley et al. [23] (1998)	Pharmaceutical care questionnaire—PCQ	English	Undefined	Instrument administered by interviewer^**	Likert-scale 1–5 (17)	227
Kassamet al. [24] (2009)	Satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15)	147
Larson et al. [25] (2002)	Pharmacy services questionnaire—PSQ	English	Patient satisfaction can be seen as a personal assessment of health care services and providers who reflect the reality of care, as well as the patient’s preferences and expectations, and can be conceptualized as an assessment of the pharmacist’s performance in patient care.	Self-administered printed instrument	Likert-scale 1–5 (20)	428
Lyra Júnior et al. [26] (2004)	Undefined	Portuguese	Patient satisfaction is defined as an outcome which reflects the degree of involvement of the pharmacist in the care process as well as the needs and expectations of the patient	Printed instrument administered by an interviewer	Likert-scale 1–5 (14); open-ended (2)	30
Moczygemba et al. [27] (2010)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15); open-ended (3)	47
Monje-Agudo et al. [28] (2015)	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	Spanish	Undefined	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	154
Moon et al. [15] (2016)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–4 (9); open-ended (1)	195

Author (year)	Name of instrument—abbreviations	Language	Construct definition	How is the administration?	Type of questions (number of questions)	Number of respondents
Armando et al. [21] (2012)	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	Spanish	Satisfaction is defined as a reflection of the provider’s ability to meet the needs of patients	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	103
Armandoet al. [22] (2005)	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	Spanish	Satisfaction is defined as a humanistic outcome of approving quality of care and reflects the provider’s ability to meet patients’ needs	Self-administered printed instrument	dichotomic (6)^*; Likert-scale 1–4 (5); open-ended (1)	40
Gourley et al. [23] (1998)	Pharmaceutical care questionnaire—PCQ	English	Undefined	Instrument administered by interviewer^**	Likert-scale 1–5 (17)	227
Kassamet al. [24] (2009)	Satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15)	147
Larson et al. [25] (2002)	Pharmacy services questionnaire—PSQ	English	Patient satisfaction can be seen as a personal assessment of health care services and providers who reflect the reality of care, as well as the patient’s preferences and expectations, and can be conceptualized as an assessment of the pharmacist’s performance in patient care.	Self-administered printed instrument	Likert-scale 1–5 (20)	428
Lyra Júnior et al. [26] (2004)	Undefined	Portuguese	Patient satisfaction is defined as an outcome which reflects the degree of involvement of the pharmacist in the care process as well as the needs and expectations of the patient	Printed instrument administered by an interviewer	Likert-scale 1–5 (14); open-ended (2)	30
Moczygemba et al. [27] (2010)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15); open-ended (3)	47
Monje-Agudo et al. [28] (2015)	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	Spanish	Undefined	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	154
Moon et al. [15] (2016)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–4 (9); open-ended (1)	195

^*Dichotomic = yes or no questions.

^**The instrument was applied by a third partial and the format (printed or digital) was not described by the authors.

Table 2.

Characteristics of the original validated instruments to measure patient satisfaction with CMM services.

Author (year)	Name of instrument—abbreviations	Language	Construct definition	How is the administration?	Type of questions (number of questions)	Number of respondents
Armando et al. [21] (2012)	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	Spanish	Satisfaction is defined as a reflection of the provider’s ability to meet the needs of patients	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	103
Armandoet al. [22] (2005)	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	Spanish	Satisfaction is defined as a humanistic outcome of approving quality of care and reflects the provider’s ability to meet patients’ needs	Self-administered printed instrument	dichotomic (6)^*; Likert-scale 1–4 (5); open-ended (1)	40
Gourley et al. [23] (1998)	Pharmaceutical care questionnaire—PCQ	English	Undefined	Instrument administered by interviewer^**	Likert-scale 1–5 (17)	227
Kassamet al. [24] (2009)	Satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15)	147
Larson et al. [25] (2002)	Pharmacy services questionnaire—PSQ	English	Patient satisfaction can be seen as a personal assessment of health care services and providers who reflect the reality of care, as well as the patient’s preferences and expectations, and can be conceptualized as an assessment of the pharmacist’s performance in patient care.	Self-administered printed instrument	Likert-scale 1–5 (20)	428
Lyra Júnior et al. [26] (2004)	Undefined	Portuguese	Patient satisfaction is defined as an outcome which reflects the degree of involvement of the pharmacist in the care process as well as the needs and expectations of the patient	Printed instrument administered by an interviewer	Likert-scale 1–5 (14); open-ended (2)	30
Moczygemba et al. [27] (2010)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15); open-ended (3)	47
Monje-Agudo et al. [28] (2015)	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	Spanish	Undefined	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	154
Moon et al. [15] (2016)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–4 (9); open-ended (1)	195

Author (year)	Name of instrument—abbreviations	Language	Construct definition	How is the administration?	Type of questions (number of questions)	Number of respondents
Armando et al. [21] (2012)	Patient satisfaction survey (Cuestionario de satisfacción de pacientes)	Spanish	Satisfaction is defined as a reflection of the provider’s ability to meet the needs of patients	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	103
Armandoet al. [22] (2005)	Patient satisfaction survey under pharmacotherapy follow-up (Cuestionario de satisfacción de pacientes bajo Seguimiento Farmacoterapéutico)	Spanish	Satisfaction is defined as a humanistic outcome of approving quality of care and reflects the provider’s ability to meet patients’ needs	Self-administered printed instrument	dichotomic (6)^*; Likert-scale 1–4 (5); open-ended (1)	40
Gourley et al. [23] (1998)	Pharmaceutical care questionnaire—PCQ	English	Undefined	Instrument administered by interviewer^**	Likert-scale 1–5 (17)	227
Kassamet al. [24] (2009)	Satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15)	147
Larson et al. [25] (2002)	Pharmacy services questionnaire—PSQ	English	Patient satisfaction can be seen as a personal assessment of health care services and providers who reflect the reality of care, as well as the patient’s preferences and expectations, and can be conceptualized as an assessment of the pharmacist’s performance in patient care.	Self-administered printed instrument	Likert-scale 1–5 (20)	428
Lyra Júnior et al. [26] (2004)	Undefined	Portuguese	Patient satisfaction is defined as an outcome which reflects the degree of involvement of the pharmacist in the care process as well as the needs and expectations of the patient	Printed instrument administered by an interviewer	Likert-scale 1–5 (14); open-ended (2)	30
Moczygemba et al. [27] (2010)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–5 (15); open-ended (3)	47
Monje-Agudo et al. [28] (2015)	Patient satisfaction assessment survey (Encuesta de valoración de la satisfacción de los pacientes)	Spanish	Undefined	Self-administered printed instrument	Likert-scale 1–5 (10); open-ended (1)	154
Moon et al. [15] (2016)	Patient satisfaction survey	English	Undefined	Self-administered printed instrument	Likert-scale 1–4 (9); open-ended (1)	195

^*Dichotomic = yes or no questions.

^**The instrument was applied by a third partial and the format (printed or digital) was not described by the authors.

Most of the original and validated instruments (seven of nine; 77.8%) [15, 21, 22, 24, 25, 27, 28] were self-administered. All instruments had closed-ended questions and six (six of nine; 66.7%) [15, 21, 22, 26–28] open-ended questions. All instruments were validated with respondents who received CMM services, except the questionnaire developed by Larson et al. [25], which was applied to patients who frequented the community pharmacy but without experiencing the CMM service.

The comparative analysis of the instruments through the checklist developed by Francis et al. [14] is presented in Table 3. The instrument by Armando et al. [21] obtained the highest score, reaching 11 out of 18 points under analysis, followed by the instrument by Larson et al. [25] (10 points) and Moon et al. [15] (10 points).

Table 3.

Critical appraisal of the original validated instruments to measure patient satisfaction with CMM services.

Checklist item	Author
Checklist item	Armando et al. [21]	Armando et al. [22]	Gourley et al. [23]	Kassam et al. [24]	Larson et al. [25]	Lyra Júnior et al. [26]	Moczygemba et al. [27]	Monje-Agudo et al. [28]	Moon et al. [15]
Conceptual model
1. Has the PRO construct to be measured been specifically defined?	1	1	0	0	1	1	0	0	0
2. Has the intended respondent population been described?	0	0	1	0	0	1	0	0	0
3. Does the conceptual model address whether a single construct/scale or multiple subscales are expected?	0	1	0	1	1	1	0	0	1
Content validity
4. Is there evidence that members of the respondent population were involved in the PRO measure’s development?	1	1	1	1	0	0	0	0	1
5. Is there evidence that content experts were involved in the PRO measure’s development?	1	1	1	1	1	1	1	1	1
6. Is there a description of the methodology by which items/questions were derived? (e.g. focus groups, interviews)?	1	1	1	1	1	1	1	1	1
Reliability
7. Is there evidence that the PRO measure´s reliability was tested (e.g. test-retest, internal consistency)?	1	1	1	1	1	0	1	1	1
8. Are reported indices of reliability adequate (e.g. ideal: r ≥ 0.80 adequate ≥ 0.70; or otherwise justified)?	1	0	0	1	1	0	1	1	1
Construct validity
9. Is there reported quantitative justification that single scale or multiple subscales exist in the PRO measure (e.g. factor analysis, item response theory)?	1	0	0	1	1	0	0	0	1
10. Are there findings supporting expected associations with existing PRO measures or other relevant data?	0	0	0	0	0	0	0	0	0
11. Are there findings supporting expected differences in scores between relevant known groups?	0	0	0	0	0	0	0	0	0
12. Is the PRO measure intended to measure change over time? If YES, is there evidence of both test-retest reliability AND responsiveness to change? Otherwise, award 1 point if there is an explicit statement that the PRO measure is NOT intended to measure change over time.	1	0	0	0	0	0	0	0	0
SCORING & INTERPRETATION
13. Is there documentation on how to score the PRO measure? (e.g. a scoring method such as summing or an algorithm)?	1	0	0	0	1	0	0	0	0
14. Has a plan for managing or interpreting missing responses been described? (i.e. how to score incomplete surveys)?	0	0	0	0	0	0	0	0	0
15. Is information provided about to interpreting the PRO measure scores? [e.g. scaling/anchors, (what high and low scores represent), normative data, or a definition of severity (mild to severe)]?	0	0	0	0	0	0	0	0	0
Respondent burden & presentation
16. Is the time to complete the reported reasonable? OR if is NOT reported, is the number of questions appropriate for the intended application?	1	1	1	1	1	1	1	1	1
17. Is there a description of the literacy level of the PRO measure?	0	0	1	0	0	0	0	0	1
18. Is the entire PRO measure available for public viewing? (e.g. published with citation or information provided about how to access a copy)?	1	0	1	1	1	0	1	1	1
Total	11	7	8	9	10	6	6	6	10

Checklist item	Author
Checklist item	Armando et al. [21]	Armando et al. [22]	Gourley et al. [23]	Kassam et al. [24]	Larson et al. [25]	Lyra Júnior et al. [26]	Moczygemba et al. [27]	Monje-Agudo et al. [28]	Moon et al. [15]
Conceptual model
1. Has the PRO construct to be measured been specifically defined?	1	1	0	0	1	1	0	0	0
2. Has the intended respondent population been described?	0	0	1	0	0	1	0	0	0
3. Does the conceptual model address whether a single construct/scale or multiple subscales are expected?	0	1	0	1	1	1	0	0	1
Content validity
4. Is there evidence that members of the respondent population were involved in the PRO measure’s development?	1	1	1	1	0	0	0	0	1
5. Is there evidence that content experts were involved in the PRO measure’s development?	1	1	1	1	1	1	1	1	1
6. Is there a description of the methodology by which items/questions were derived? (e.g. focus groups, interviews)?	1	1	1	1	1	1	1	1	1
Reliability
7. Is there evidence that the PRO measure´s reliability was tested (e.g. test-retest, internal consistency)?	1	1	1	1	1	0	1	1	1
8. Are reported indices of reliability adequate (e.g. ideal: r ≥ 0.80 adequate ≥ 0.70; or otherwise justified)?	1	0	0	1	1	0	1	1	1
Construct validity
9. Is there reported quantitative justification that single scale or multiple subscales exist in the PRO measure (e.g. factor analysis, item response theory)?	1	0	0	1	1	0	0	0	1
10. Are there findings supporting expected associations with existing PRO measures or other relevant data?	0	0	0	0	0	0	0	0	0
11. Are there findings supporting expected differences in scores between relevant known groups?	0	0	0	0	0	0	0	0	0
12. Is the PRO measure intended to measure change over time? If YES, is there evidence of both test-retest reliability AND responsiveness to change? Otherwise, award 1 point if there is an explicit statement that the PRO measure is NOT intended to measure change over time.	1	0	0	0	0	0	0	0	0
SCORING & INTERPRETATION
13. Is there documentation on how to score the PRO measure? (e.g. a scoring method such as summing or an algorithm)?	1	0	0	0	1	0	0	0	0
14. Has a plan for managing or interpreting missing responses been described? (i.e. how to score incomplete surveys)?	0	0	0	0	0	0	0	0	0
15. Is information provided about to interpreting the PRO measure scores? [e.g. scaling/anchors, (what high and low scores represent), normative data, or a definition of severity (mild to severe)]?	0	0	0	0	0	0	0	0	0
Respondent burden & presentation
16. Is the time to complete the reported reasonable? OR if is NOT reported, is the number of questions appropriate for the intended application?	1	1	1	1	1	1	1	1	1
17. Is there a description of the literacy level of the PRO measure?	0	0	1	0	0	0	0	0	1
18. Is the entire PRO measure available for public viewing? (e.g. published with citation or information provided about how to access a copy)?	1	0	1	1	1	0	1	1	1
Total	11	7	8	9	10	6	6	6	10

Table 3.

. https://doi.org/10.1177/1060028018765159

Critical appraisal of the original validated instruments to measure patient satisfaction with CMM services.

Checklist item	Author
Checklist item	Armando et al. [21]	Armando et al. [22]	Gourley et al. [23]	Kassam et al. [24]	Larson et al. [25]	Lyra Júnior et al. [26]	Moczygemba et al. [27]	Monje-Agudo et al. [28]	Moon et al. [15]
Conceptual model
1. Has the PRO construct to be measured been specifically defined?	1	1	0	0	1	1	0	0	0
2. Has the intended respondent population been described?	0	0	1	0	0	1	0	0	0
3. Does the conceptual model address whether a single construct/scale or multiple subscales are expected?	0	1	0	1	1	1	0	0	1
Content validity
4. Is there evidence that members of the respondent population were involved in the PRO measure’s development?	1	1	1	1	0	0	0	0	1
5. Is there evidence that content experts were involved in the PRO measure’s development?	1	1	1	1	1	1	1	1	1
6. Is there a description of the methodology by which items/questions were derived? (e.g. focus groups, interviews)?	1	1	1	1	1	1	1	1	1
Reliability
7. Is there evidence that the PRO measure´s reliability was tested (e.g. test-retest, internal consistency)?	1	1	1	1	1	0	1	1	1
8. Are reported indices of reliability adequate (e.g. ideal: r ≥ 0.80 adequate ≥ 0.70; or otherwise justified)?	1	0	0	1	1	0	1	1	1
Construct validity
9. Is there reported quantitative justification that single scale or multiple subscales exist in the PRO measure (e.g. factor analysis, item response theory)?	1	0	0	1	1	0	0	0	1
10. Are there findings supporting expected associations with existing PRO measures or other relevant data?	0	0	0	0	0	0	0	0	0
11. Are there findings supporting expected differences in scores between relevant known groups?	0	0	0	0	0	0	0	0	0
12. Is the PRO measure intended to measure change over time? If YES, is there evidence of both test-retest reliability AND responsiveness to change? Otherwise, award 1 point if there is an explicit statement that the PRO measure is NOT intended to measure change over time.	1	0	0	0	0	0	0	0	0
SCORING & INTERPRETATION
13. Is there documentation on how to score the PRO measure? (e.g. a scoring method such as summing or an algorithm)?	1	0	0	0	1	0	0	0	0
14. Has a plan for managing or interpreting missing responses been described? (i.e. how to score incomplete surveys)?	0	0	0	0	0	0	0	0	0
15. Is information provided about to interpreting the PRO measure scores? [e.g. scaling/anchors, (what high and low scores represent), normative data, or a definition of severity (mild to severe)]?	0	0	0	0	0	0	0	0	0
Respondent burden & presentation
16. Is the time to complete the reported reasonable? OR if is NOT reported, is the number of questions appropriate for the intended application?	1	1	1	1	1	1	1	1	1
17. Is there a description of the literacy level of the PRO measure?	0	0	1	0	0	0	0	0	1
18. Is the entire PRO measure available for public viewing? (e.g. published with citation or information provided about how to access a copy)?	1	0	1	1	1	0	1	1	1
Total	11	7	8	9	10	6	6	6	10

Checklist item	Author
Checklist item	Armando et al. [21]	Armando et al. [22]	Gourley et al. [23]	Kassam et al. [24]	Larson et al. [25]	Lyra Júnior et al. [26]	Moczygemba et al. [27]	Monje-Agudo et al. [28]	Moon et al. [15]
Conceptual model
1. Has the PRO construct to be measured been specifically defined?	1	1	0	0	1	1	0	0	0
2. Has the intended respondent population been described?	0	0	1	0	0	1	0	0	0
3. Does the conceptual model address whether a single construct/scale or multiple subscales are expected?	0	1	0	1	1	1	0	0	1
Content validity
4. Is there evidence that members of the respondent population were involved in the PRO measure’s development?	1	1	1	1	0	0	0	0	1
5. Is there evidence that content experts were involved in the PRO measure’s development?	1	1	1	1	1	1	1	1	1
6. Is there a description of the methodology by which items/questions were derived? (e.g. focus groups, interviews)?	1	1	1	1	1	1	1	1	1
Reliability
7. Is there evidence that the PRO measure´s reliability was tested (e.g. test-retest, internal consistency)?	1	1	1	1	1	0	1	1	1
8. Are reported indices of reliability adequate (e.g. ideal: r ≥ 0.80 adequate ≥ 0.70; or otherwise justified)?	1	0	0	1	1	0	1	1	1
Construct validity
9. Is there reported quantitative justification that single scale or multiple subscales exist in the PRO measure (e.g. factor analysis, item response theory)?	1	0	0	1	1	0	0	0	1
10. Are there findings supporting expected associations with existing PRO measures or other relevant data?	0	0	0	0	0	0	0	0	0
11. Are there findings supporting expected differences in scores between relevant known groups?	0	0	0	0	0	0	0	0	0
12. Is the PRO measure intended to measure change over time? If YES, is there evidence of both test-retest reliability AND responsiveness to change? Otherwise, award 1 point if there is an explicit statement that the PRO measure is NOT intended to measure change over time.	1	0	0	0	0	0	0	0	0
SCORING & INTERPRETATION
13. Is there documentation on how to score the PRO measure? (e.g. a scoring method such as summing or an algorithm)?	1	0	0	0	1	0	0	0	0
14. Has a plan for managing or interpreting missing responses been described? (i.e. how to score incomplete surveys)?	0	0	0	0	0	0	0	0	0
15. Is information provided about to interpreting the PRO measure scores? [e.g. scaling/anchors, (what high and low scores represent), normative data, or a definition of severity (mild to severe)]?	0	0	0	0	0	0	0	0	0
Respondent burden & presentation
16. Is the time to complete the reported reasonable? OR if is NOT reported, is the number of questions appropriate for the intended application?	1	1	1	1	1	1	1	1	1
17. Is there a description of the literacy level of the PRO measure?	0	0	1	0	0	0	0	0	1
18. Is the entire PRO measure available for public viewing? (e.g. published with citation or information provided about how to access a copy)?	1	0	1	1	1	0	1	1	1
Total	11	7	8	9	10	6	6	6	10

During the evaluation of the conceptual model attribute, it was identified that the definition of the construct “satisfaction” was described for four instruments (four of nine; 44.4%) [21, 22, 25, 26]. The intended respondent population (outpatients) was described for only two instruments [23, 26]. For five instruments (five of nine; 55.6%) [15, 22, 24–26], the authors previously defined that one or more scales were expected.

In the content validity evaluation, the description of the construction methodology of all instruments was identified, which included the participation of experts in their development. For more than half of the instruments (five of nine; 55.6%) [15, 21–24], the respondent population was also involved during their development.

Reliability evaluation was performed for most of the instruments (n = 8) [15, 21–25, 27, 28], and the internal consistency analysis was adopted in all of these cases, involving the calculation of the Cronbach’s alpha coefficient. For two instruments [22, 23], the reliability value did not reach adequate indexes (≥0.70).

The construct validity for the instruments was poorly described by their authors. In the four studies [15, 21, 24, 25] that performed this evaluation partially, factor analyses to identify the relationship among the proposed questions were carried out. With regard to responsiveness to change, the inability to measure changes in patient satisfaction over time was reported for only one of the instruments [21].

For the scoring and interpretation attribute, the instruction on how to reach the final score for the questionnaire was presented for only two instruments [21, 25], although the score’s interpretation was not described. In addition, a management plan for missing responses was not observed for any of the instruments evaluated.

In the respondent burden and presentation attribute evaluation, the response time was considered adequate for all instruments, since the instruments were simple, they had few questions, and most of their questions were closed. Only two studies described the educational level required to answer the instruments, namely 9.52 years of study for Gourley et al. [23] and 8.5 years of study for Moon et al. [15] Furthermore, it was observed that most of the instruments (n = 7; 77.8%) [15, 21, 23–25, 27, 28] were published in their totality in the original study; the other two [22, 26] were not fully published and were obtained only after direct request to the corresponding authors by e-mail.

Discussion

This scoping review, to the authors’ knowledge, was the first to map, identify, and compare the characteristics of patient satisfaction measurement instruments for CMM services available in the literature. Measuring patient satisfaction, a humanistic outcome indicator, in a patient-centred service such as CMM is of great relevance, especially as health systems seek to implement outcome-based payment models [5, 48].

Regarding the place of origin of the included studies, the results show a predominance of publications in the USA (n = 10), which can be explained by this country being the birthplace of Pharmaceutical Care practice [2]. The implementation of the service in the USA was also driven by the Medicare Part D health insurance coverage in 2006, as reported by Gray et al. [49].

The retrieved studies show a wide variation of terms to describe the CMM service, but there was a predominance of the use of “Pharmaceutical Care”, consistent with the largest volume of publications in the USA, where the term was created. The term CMM was used in more recent studies [15, 43, 47].

Among the retrieved studies, the use of instruments translated and adapted from another language was frequent, with a predominance of the instrument developed by Larson et al. [25] (n=10). The instrument divides the questions into “Friendly Explanation” and “Managing Therapy,” where the first deals with aspects of care and staff attitude, while the second involves the pharmacist’s responsibility regarding the pharmacotherapy of their patient. Although it scored only 10 out of 18 points on the PRO measures assessment score, the wide applicability of the instrument may have motivated a greater number of translations and cultural adaptations.

Most of the original validated instruments were self-administered (n = 7), which is consistent with the recommendations for PRO measures instruments, leading to more reliable answers from the patient. The instruments proposed by Gourley et al. [23] and Lyra Júnior et al. [26] were applied through interviews conducted by previously trained professionals, which can compromise the veracity of the information due to the patient’s embarrassment before the interviewer, as reported by Aspinal et al. [50] Moreover, the results of high satisfaction commonly found in clinical service evaluations can be compromised by the so-called gratitude bias, in which the patient is grateful for the simple fact of being guaranteed the service and tends to exaggerate the positive responses, as described by Alves and Trad [51]. The interview format could potentiate this tendency, inhibiting negative answers from the patient.

It was also observed that the use of closed and open-ended questions was adopted for most of the instruments (n = 6), which is in accordance with the recommendations when dealing with quantitative and qualitative methods in measuring satisfaction: the former tends to be reductionist and does not always translate what the user expresses; and the latter may inhibit negative responses in the personal meeting with the interviewer, besides requiring more time for collection and analysis. The combination of the two methods can bring complementarity to the research and avoid the effect of high satisfaction [51].

In general, the instruments did not completely fulfill the desirable standards for measuring patient satisfaction according to Francis et al. [14], showing a low total score for the checklist. The description of the construct “satisfaction” to be measured was absent or superficially described, contrary to what is recommended [14]. Without a clear definition, respondents may have different ideas about the concept, which may impact the measured result [52]. However, the lack of a theoretical definition for satisfaction with health services is recognized, and, although several authors have dedicated themselves to the topic, there is no consensus on the concept [50].

Also, no definition of the intended respondent population was presented for most of the instruments (n = 8), leaving room to use the instrument in any profile of the population. The literature highlights some patient profile factors that may impact the measure of satisfaction with a health service. Age is one of these factors: older patients often tend to be easier to please and to have lower expectations, which can lead to a higher degree of satisfaction. It is also known that women tend to be more critical of healthcare services [53]. Studies in Brazil have also shown that people with lower incomes tend to be more satisfied with healthcare services [53]. Therefore, it is very important to clearly define to which respondents the instrument is intended.

Another factor that can lead to bias in satisfaction measures is related to temporality: surveys applied in healthcare services right after the service is offered are aimed at the user’s concrete experience, avoiding memory bias. However, the answers are more associated with the provider-patient relationship and the explanations received by the user during the consultation. In contrast, some authors state that patients tend to be more critical of the services over time or remember more negative aspects, which are usually more striking, compromising late-answered surveys [51]. None of the instruments evaluated in this study clearly defined the recommended temporal circumstances for the application of the instrument, which may compromise the results.

With respect to the development of the instrument, a little more than half (n = 5) of the instruments evaluated described the participation of the respondent population in its development, recommended to ensure content validity, as well as clarity and understanding of the questions by the intended population [54]. The absence of an analysis of the literacy level of the survey by a large part of the instruments (n = 7) contradicts literature recommendations, since socio-economic and cultural differences of the population may require adaptations of the PRO measures, adapting them to the educational level of the patients investigated [51].

Regarding the assessment of the psychometric properties of the instruments, it was observed that they focused mainly on reliability tests that designate the level at which results are free of random errors. This gap implies that there was no assessment, e.g. of responsiveness to change when the same instrument is used to reassess the service after an intervention. The absence of this criterion is particularly important for researchers seeking to compare the effectiveness of interventions [14]. Also, the following tests were not performed for any of the instruments: the performance of “convergent validity” tests, which compare the instrument with other models that measure the same construct; or the “divergent validity” tests, which require the questionnaire to differentiate notably different groups.

Concerning the interpretability of the answers obtained, all the instruments evaluated demonstrated fragility in this aspect. For instance, there was no description of the meaning of the scores obtained in the instrument, indicating, e.g. a cutoff point from which it is necessary to improve the service due to the negative answers of the respondents. Considering also that most of the instruments are self-administered, it is necessary to consider possible failures in the complete or partial return of the document, and none of the authors presented a plan to treat the missing answers, as recommended in the literature [14].

Considering all the points evaluated in the proposed checklist, it is worth emphasizing the instrument developed by Armando et al. [21], which achieved the highest score in this analysis (11 points). The authors developed a simple instrument with 10 closed questions and one open-ended question, self-administered, to evaluate satisfaction as a humanistic result of CMM services offered in Spanish pharmacies. To this end, they counted on the participation of experts and patients in its development. The validation carried out with 103 respondents involved the reliability test and factor analysis that showed that all items are correlated (single factor). It was distinguished from the other instruments because it was the only one that reported as a limitation the absence of responsiveness to changes, and, therefore, it is believed that it should not be used to measure improvements in the services evaluated.

The instrument developed by Larson et al. [25], in contrast, which achieved second place in the score (10 points), is more extensive, presenting 20 self-applied closed questions. As a limitation, patients were not involved in its development. Therefore, face validity and clarity of the questions were not evaluated, but a robust validation resulted in high reliability (Cronbach’s alpha of 0.873). The authors point to a “before and after” measurement of the CMM implementation as the most suitable use for the instrument, although they did not perform tests to ensure the responsiveness of the questionnaire to changes, such as test–retest. It is important to emphasize that the instrument was answered by people who had not been included in CMM services, but were habitual in the pharmacies investigated, which is a limitation of the study. It is worth reflecting on the construct that was evaluated in this case: satisfaction with the service or expectation. Aspinal et al. [50] assert in their study that there is no consensus in the literature on the relationship between satisfaction and expectation, with divergent results on this topic. Those authors question whether the results of satisfaction surveys really reflect a quality service or just a better service than expected. In the specific case of the instrument developed by Larson et al. [25], the positive responses may be impaired by low expectations of a service that the patients did not even experience. However, the authors justify that the objective of the study was the development of the instrument and not exactly the measurement of satisfaction with the CMM service.

The instrument developed by Moon et al. [15], which also ranked second in overall score (10 points), proposed to briefly evaluate, in 10 closed questions and one open-ended question, three domains related to CMM satisfaction: 1. needs to be related to medication; 2. the role of the pharmacist from the patient’s point of view; 3. overall satisfaction with the service. The instrument was developed by specialists and modified after focus groups with patients. It stands out from the other two highest-scoring instruments because it was the only one that assessed the respondents’ level of literacy (8.5 years). It was submitted to a new psychometric evaluation by Campbell et al. [47] in 2022, who concluded that it should not be used on a large scale to compare the quality of the CMM services provided, although it may be useful to monitor patient satisfaction as an indicator of the quality of a specific service.

As limitations of this review, we can cite the extensive variety of terms to refer to clinical pharmaceutical services. There is great difficulty in standardizing the service provided, making it difficult to find an instrument to measure satisfaction specifically for CMM services. In addition, some studies did not contain complete information for understanding the type of service offered, did not present the measurement instrument in full, or were published only as conference abstracts, without sufficient data for eligibility analysis, even after several attempts to contact the authors. A methodological limitation was conducting the search in the gray literature only in two Brazilian theses and dissertation databases, due to restricted access to other international databases. Another limitation of the present review was the lack of description of information on determining the sample in the included studies or the methods used in the adaptation or validation of the instruments used in these studies.

As a strength of the study, we highlight the high sensitivity of the search strategies used, which involved different terms potentially associated with the CMM service in seven different databases, in addition to the search in the gray literature and an extensive manual search, aiming to avoid possible publication biases in mapping the literature on the subject. Furthermore, the study was conducted according to the methodology recommended by JBI [17] and PRISMA [16] and with several validation phases, conferring robustness to the search and selection method.

The review shows that there is room for improvement of the identified instruments to meet the requirements for a PRO measure. We emphasize as main points for adjustment the need for a clear definition for the construct “satisfaction” to be measured, as well as the description of the intended respondents; the guarantee of involvement of the intended population in the development of the instrument; the validation of the instruments to measure changes over time; and the clear definition of how to score the instrument, including cutoff points that signal the need for intervention in the care process.

These gaps identified in the development of instruments for measuring satisfaction with CMM services should be taken into consideration in future research, aiming to build a robust and standardized instrument for the service.

Conclusion

The scoping review made it possible to identify the instruments available for measuring patient satisfaction with CMM services, an important humanistic indicator. It was also able to comparatively highlight the characteristics and psychometric properties of the originally validated instruments and point out those that most frequently met the desirable criteria for this type of instrument (PRO measure). However, improvement is needed in many of the evaluated domains of the instruments to meet the desirable requirements for a PRO measure. These gaps should be taken into consideration in future research, aiming to build a robust and standardized instrument for the CMM service.

Author Contributions

Conceptualization: Lorayne Caroline Resende, Edna Afonso Reis, Mariana Martins Gonzaga do Nascimento; Methodology: Lorayne Caroline Resende, Mariana Michel Barbosa, Cristiane de Paula Rezende, Laís Lessa Neiva Pantuza, Edna Afonso Reis, Mariana Martins Gonzaga do Nascimento; Formal analysis and investigation: Lorayne Caroline Resende, Cristiane de Paula Rezende, Mariana Martins Gonzaga do Nascimento; Writing—original draft preparation: Lorayne Caroline Resende; Writing—review and editing: Lorayne Caroline Resende, Mariana Michel Barbosa, Cristiane de Paula Rezende, Laís Lessa Neiva Pantuza, Edna Afonso Reis, Mariana Martins Gonzaga do Nascimento; Funding acquisition: Mariana Martins Gonzaga do Nascimento, Edna Afonso Reis; Resources: Mariana Martins Gonzaga do Nascimento, Edna Afonso Reis; Supervision: Mariana Michel Barbosa, Edna Afonso Reis, Mariana Martins Gonzaga do Nascimento.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Funding

This work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG).

Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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