International Journal of Clinical Pharmacy

, Volume 40, Issue 1, pp 3–14 | Cite as

Pharmaceutical care and health related quality of life outcomes over the past 25 years: Have we measured dimensions that really matter?

  • Mohammed A. MohammedEmail author
  • Rebekah J. Moles
  • Timothy F. Chen
Review Article


Background Several measures of Health-Related Quality of Life (HRQoL) have been used to evaluate Pharmaceutical Care (PC) interventions in the past decades. However, their suitability for evaluation of PC services has not been comprehensively evaluated. Aim of the review The aim of this review was to perform content analysis of HRQoL measures used in PC studies to gain an insight into their suitability for evaluation of PC services. Method PC studies evaluating HRQoL as a primary or secondary outcomes were retrieved based on a literature search of articles published from 1990 to 2015, on Medline, Embase, International Pharmaceutical Abstracts, Global Health, PsycInfo, Web of Science, Cinahl, HealthStar, Cochrane Library, AUSThealth, Australian Medical Index, and Current content. Measures of HRQoL used in the studies were identified and relevant information was extracted. A conceptual model of a patient reported Medication-Related Burden Quality of Life was used to guide the analysis. Results 117 studies were retrieved. Thirty-seven: 10 generic, 27 condition-specific HRQoL measures with a total of 1019 items about physical functioning (n = 430), psychological wellbeing (n = 288), social wellbeing (n = 119), physical burden (n = 69) and others (n = 113) were used in the studies. Only 34 of 1019 items were specifically related to medicines. Of these, the majority of items focused on other aspects of medicine such as adherence, rather than the burden imposed by medicine on quality of life. Conclusion A holistic analysis of HRQoL measures used in PC studies published over two and half decades provided a better insight into sensitivity and specificity of the measures to PC services. This review found that HRQoL measures used in PC studies provide a very limited coverage of themes related to the burden of medicine on quality of life. Therefore, may have limited potential for use as a sole humanistic measure when evaluating PC interventions. There is a scope for future research in the development of an alternative measure suitable for evaluation of the burden of medicine and the impact of PC interventions on quality of life outcomes.


Content analysis Health related quality of life Medication-related burden Patient reported outcome measure Pharmaceutical care 



This work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (PDF 276 kb)
11096_2017_582_MOESM2_ESM.pdf (389 kb)
Supplementary material 2 (PDF 389 kb)


  1. 1.
    Mohammed MA, Moles RJ, Chen TF. Medication-related burden and patients’ lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open. 2016;6(2):e010035.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2015;18(3):312–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Tran V-T, Barnes C, Montori VM, Falissard B, Ravaud P. Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. BMC Med. 2015;13(1):1–15.CrossRefGoogle Scholar
  4. 4.
    Krska J, Morecroft CW, Poole H, Rowe PH. Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study. Int J Clin Pharm. 2013;35(6):1161–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Murawski MM, Bentley JP. Pharmaceutical therapy-related quality of life: conceptual development. J Soc Adm Pharm. 2001;18(1):2–14.Google Scholar
  6. 6.
    Loonen HJ, Derkx BH, Otley AR. Measuring health-related quality of life of pediatric patients. J Pediatr Gastroenterol Nutr. 2001;32(5):523–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol. 1992;45(7):743–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Rapkin BD, Schwartz CE. Toward a theoretical model of quality-of-life appraisal: implications of findings from studies of response shift. Health Qual Life Outcomes. 2004;2:14.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Petersson C, Simeonsson RJ, Enskar K, Huus K. Comparing children’s self-report instruments for health-related quality of life using the international classification of functioning, disability and health for children and youth (ICF-CY). Health Qual Life Outcomes. 2013;11:75.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    US Food and Drug Administration. Guidance for industry patientreported outcome measures: Use in medial product developmental to support labeling claims [internet]. Draft guidance; 2009. Accessed 8 Oct 2017.
  11. 11.
    Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993;118(8):622–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Carlton J, Kaltenthaler E. Health-related quality of life measures (HRQoL) in patients with amblyopia and strabismus: a systematic review. Br J Ophthalmol. 2011;95(3):325–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Mohammed MA, Moles RJ, Chen TF. Impact of pharmaceutical care interventions on health-related quality-of-life outcomes: a systematic review and meta-analysis. Ann Pharmacother. 2016;50(10):862–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Pickard AS, Hung S-Y. An update on evidence of clinical pharmacy services’ impact on health-related quality of life. Ann Pharmacother. 2006;40(9):1623–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Pickard AS, Johnson JA, Farris KB. The impact of pharmacist interventions on health-related quality of life. Ann Pharmacother. 1999;33(11):1167–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Roughead EE, Semple SJ, Vitry AI. Pharmaceutical care services: a systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes. Int J of Pharm Pract. 2005;13(1):53–70.CrossRefGoogle Scholar
  17. 17.
    Quittner AL, Modi A, Cruz I. Systematic review of health-related quality of life measures for children with respiratory conditions. Paediatr Respir Rev. 2008;9(3):220–32.CrossRefPubMedGoogle Scholar
  18. 18.
    Kheir NM, van Mil JW, Shaw JP, Sheridan JL. Health-related quality of life measurement in pharmaceutical care. Targeting an outcome that matters. Pharm World Sci. 2004;26(3):125–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Marks GB, Dunn SM, Woolcock AJ. A scale for the measurement of quality of life in adults with asthma. J Clin Epidemiol. 1992;45(5):461–72.CrossRefPubMedGoogle Scholar
  20. 20.
    Christie MJ, French D, Sowden A, West A. Development of child-centered disease-specific questionnaires for living with asthma. Psychosom Med. 1993;55(6):541–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Burroughs TE, Desikan R, Waterman BM, Gilin D, McGill J. Development and validation of the diabetes quality of life brief clinical inventory. Diabetes Spectr. 2004;17(1):41–9.CrossRefGoogle Scholar
  22. 22.
    Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, et al. Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg. 1995;82(2):216–22.CrossRefPubMedGoogle Scholar
  23. 23.
    Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax. 1992;47(2):76–83.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hyland ME, Finnis S, Irvine SH. A scale for assessing quality of life in adult asthma sufferers. J Psychosom Res. 1991;35(1):99–110.CrossRefPubMedGoogle Scholar
  25. 25.
    Endicott J, Nee J, Harrison W, Blumenthal R. Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–6.PubMedGoogle Scholar
  26. 26.
    Cramer JA, Perrine K, Devinsky O, Bryant-Comstock L, Meador K, Hermann B. Development and cross-cultural translations of a 31-item quality of life in epilepsy inventory. Epilepsia. 1998;39(1):81–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Jones PW, Quirk FH, Baveystock CM. The St George’s Respiratory Questionnaire. Respir Med. 1991;85:25–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Wan C, Meng Q, Yang Z, Tu X, Feng C, Tang X, et al. Validation of the simplified Chinese version of EORTC QLQ-C30 from the measurements of five types of inpatients with cancer. Ann Oncol. 2008;19(12):2053–60.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Wan C, Yang Z, Meng Q, Feng C, Wang H, Tang X, et al. Development and validation of the general module of the system of quality of life instruments for cancer patients. Int J Cancer. 2008;122(1):190–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Gourley GA, Portner TS, Gourley DR, Rigolosi EL, Holt JM, Solomon DK, et al. Humanistic outcomes in the hypertension and COPD arms of a multicenter outcomes study. J Am Pharm Assoc (Wash). 1998;38(5):586–97.CrossRefGoogle Scholar
  31. 31.
    Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health. 1980;34(4):281–6.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    World Health Organization (WHO) Introduction, administration, scoring, and generic version of the assessment [online] 1996. Accessed 18 Feb 2016.
  33. 33.
    Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Rector TS, Kubo SH, Cohn JN. Patients’ selfassessment of their congestive heart failure. Part 2: content, reliability and validity of a new measure, The Minnesota Living with Heart Failure Questionnaire. Heart Fail. 1987;3:198–209.Google Scholar
  35. 35.
    Sawicki PT. A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. Working Group for the Study of Patient Self-Management of Oral Anticoagulation. JAMA. 1999;281(2):145–50.CrossRefPubMedGoogle Scholar
  36. 36.
    Salek SS. Quality of life in patients with end-stage renal disease. J Appl Ther. 1999;2:163–70.Google Scholar
  37. 37.
    Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.PubMedGoogle Scholar
  38. 38.
    Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, et al. Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European foundation for osteoporosis. Osteoporos Int. 1997;7(1):36–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Jacobson GP, Ramadan NM, Aggarwal SK, Newman CW. The henry ford hospital headache disability inventory (HDI). Neurology. 1994;44(5):837–42.CrossRefPubMedGoogle Scholar
  41. 41.
    Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72.CrossRefPubMedGoogle Scholar
  42. 42.
    Bentsen BG, Natvig B, Winnem M. Questions you didn’t ask? COOP/WONCA charts in clinical work and research. World Organization of Colleges, Academies and Academic Associations of General Practitioners/Family Physicists. Fam Pract. 1999;16(2):190–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Gaston JE, Vogl L. Psychometric properties of the general well-being index. Qual Life Res. 2005;14(1):71–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Olufade AO, Shaw JW, Foster SA, Leischow SJ, Hays RD, Coons SJ. Development of the Smoking Cessation Quality of Life questionnaire. Clin Ther. 1999;21(12):2113–30.CrossRefPubMedGoogle Scholar
  45. 45.
    Goodman M, Hull JW, Terkelsen KG, Smith TE, Anthony D. Factor structure of quality of life: the Lehman interview. Eval Program Plan. 1997;20(4):477–80.CrossRefGoogle Scholar
  46. 46.
    Lehman AF. A quality of life interview for the chronically mentally ill. Eval Program Plan. 1988;11(1):51–62.CrossRefGoogle Scholar
  47. 47.
    Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N. The PDQ-8: development and validation of a short-form parkinson’s disease questionnaire. Psychol Health. 1997;12(6):805–14.CrossRefGoogle Scholar
  48. 48.
    Kopec JA, Sayre EC, Davis AM, Badley EM, Abrahamowicz M, Pouchot J, et al. Development of a paper-and-pencil semi-adaptive questionnaire for 5 domains of health-related quality of life (PAT-5D-QOL). Qual Life Res. 2013;22(10):2829–42.CrossRefPubMedGoogle Scholar
  49. 49.
    Binkley JM, Stratford PW, Lott SA, Riddle DL. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. North American orthopaedic rehabilitation research network. Phys Ther. 1999;79(4):371–83.PubMedGoogle Scholar
  50. 50.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.CrossRefPubMedGoogle Scholar
  51. 51.
    Bradley C, Todd C, Gorton T, Symonds E, Martin A, Plowright R. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res. 1999;8(1–2):79–91.CrossRefPubMedGoogle Scholar
  52. 52.
    Bulpitt CJ, Fletcher AE. The measurement of quality of life in hypertensive patients: a practical approach. Br J Clin Pharmacol. 1990;30(3):353–64.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD assessment test. Eur Respir J. 2009;34(3):648–54.CrossRefPubMedGoogle Scholar
  54. 54.
    Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in children with asthma. Qual Life Res. 1996;5(1):35–46.CrossRefPubMedGoogle Scholar
  55. 55.
    Feeny D, Furlong W, Torrance GW, Goldsmith CH, Zhu Z, DePauw S, et al. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care. 2002;40(2):113–28.CrossRefPubMedGoogle Scholar
  56. 56.
    Guyatt GH, Nogradi S, Halcrow S, Singer J, Sullivan MJ, Fallen EL. Development and testing of a new measure of health status for clinical trials in heart failure. J Gen Intern Med. 1989;4(2):101–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York: McGraw-Hill; 1998.Google Scholar
  58. 58.
    Malone DC, Carter BL, Billups SJ, Valuck RJ, Barnette DJ, Sintek CD, et al. Can clinical pharmacists affect SF-36 scores in veterans at high risk for medication-related problems? Med Care. 2001;39(2):113–22.CrossRefPubMedGoogle Scholar
  59. 59.
    Loh ZWR, Cheen MHH, Wee HL. Humanistic and economic outcomes of pharmacist-provided medication review in the community-dwelling elderly: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(6):621–33.CrossRefPubMedGoogle Scholar
  60. 60.
    Kjeldsen LJ, Nielsen TR, Olesen C. The challenges of outcome research. Int J Clin Pharm. 2016;38(3):705–8.PubMedGoogle Scholar
  61. 61.
    Krska J, Rowe PH. Outcome measures: a sensitive approach. Int J Pharm Pract. 2010;18(2):125–7.PubMedGoogle Scholar
  62. 62.
    Sakthong P, Suksanga P, Sakulbumrungsil R, Winit-Watjana W. Development of patient-reported outcomes measure of pharmaceutical therapy for quality of life (PROMPT-QoL): a novel instrument for medication management. Res Soc Adm Pharm. 2015;11(3):315–38.CrossRefGoogle Scholar
  63. 63.
    Tseng HM, Lee CH, Chen YJ, Hsu HH, Huang LY, Huang JL. Developing a measure of medication-related quality of life for people with polypharmacy. Qual Life Res. 2016;25(5):1295–302.CrossRefPubMedGoogle Scholar
  64. 64.
    Cohen LL, La Greca AM, Blount RL, Kazak AE, Holmbeck GN, Lemanek KL. Introduction to special issue: evidence-based assessment in pediatric psychology. J Pediatr Psychol. 2008;33(9):911–5.CrossRefPubMedGoogle Scholar
  65. 65.
    Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol. 2010;10:22.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2012;21(4):651–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mohammed A. Mohammed
    • 1
    Email author
  • Rebekah J. Moles
    • 1
  • Timothy F. Chen
    • 1
  1. 1.Faculty of PharmacyThe University of SydneySydneyAustralia

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