International Journal of Pharmacy Practice最新文献

{"title":"The Impact of Electronic Prescribing System Factors on Prescribing Decision Making: A Systematic Review and Narrative Synthesis","authors":"N. Alaboud, Y. Jani, B. D. Franklin","doi":"10.1093/ijpp/riad074.003","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.003","url":null,"abstract":"Medication prescribing is a complex and error-prone process in clinical practice1. Using electronic prescribing systems (EP) allow healthcare providers to prescribe medications electronically. However, many factors can affect the implementation and utilisation of EP systems, including factors related to the end-users, system, and organization2. This systematic review aimed to explore and synthesise the literature on the impact of EP system factors on prescribing decision-making. Objectives were to: map the current evidence for EP system factors that inhibit or facilitate prescribing decision-making; identify the positive and negative impact of different design features or data integration of EP systems on prescribing decision-making; identify evidence on the most effective ways to display patient-specific data to aid prescribers in making their prescribing decisions; and make recommendations for future clinical practice and research in designing EP systems. We searched PubMed, Medline, Embase and the Cumulative Index to Nursing Allied Health Literature databases for studies published from January 2000 to February 2023 We included all types of primary studies (both evaluative and descriptive study designs) that explored the effect of EP system factors on prescribing decision-making in any healthcare setting. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT)3. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration: CRD42021235988). Searches identified 6752; after deduplication, 4925 articles underwent title and abstract screening, and 227 underwent full-text review, of which 54 were included from 13 different countries. There were a range of study designs; most (n=30) adopted quantitative methods such as retrospective evaluation by extracting the data from an EP system, nine adopted qualitative approaches such as interviews, and a further 15 used mixed methods. According to MMAT, 32 of 54 studies were deemed to be of high quality. Based on the findings of included studies, three key EP system factors were derived that could affect medication-related decision-making during prescribing processes: (1) design features of CDSS within EP system (how the EP system design interact with the prescriber at the point of prescribing and which design feature has been used), (2) displayed information at the point of prescribing (what and how data displayed to the prescriber at point of prescribing) and (3) Type of EP system based on the system developer (a commercial vs. a homegrown EP system). A total of 18 EP system factors were found that have either positive or negative effects on influencing prescribers’ decision-making and prescribing workflow. The end-users of the EP system played essential roles in system acceptance, and its success in real practices. However, there is a need for more consensus within the literature on designi","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the impact of a Pharmacy Technician within the Emergency Department, Royal Stoke University Hospital","authors":"B. A. Jacklin, V. J. Marson, N. Bailey, F. Bevan","doi":"10.1093/ijpp/riad074.030","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.030","url":null,"abstract":"The Emergency Department (ED) at the Royal Stoke University Hospital has come under increasing pressure, and it is well published that patients within the ED are at a higher risk of medication misadventure and missed doses of critical medicines1. This was a particular risk at the Royal Stoke in winter 2022/23 with the re-introduction of ED corridor care and patients waiting over 24 hours for a medical bed. A prescribing pharmacist has been in post in the ED since 2019, but additional funding was obtained for a pharmacy ED technician to support for 6 months during winter pressures. The aim of this service evaluation was to assess the impact of the pharmacy technician within the ED, with a particular focus on medicines reconciliation, allergy status recognition and pharmacist prescribing activity. Ethical approval was not required for this project, as it was a service evaluation. Data was collected over an 11 week period, Monday-Friday from October-December 2022. Data was collated into an Excel® spread sheet and assessed the number of patients reviewed by the pharmacy technician and prescribing pharmacist, the number of medicines prescribed by a prescribing pharmacist (including number of critical and non-critical medicines), and any missed allergy status’ by the clerking practitioner. Over 11 weeks, the pharmacist prescriber was able to prescribe 183 medicines, 46 of which were critical medicines. 23 patients were identified as having allergies (with 61% being penicillin allergy) which had previously not been documented by the clerking practitioner within the ED and/or patients were not wearing the appropriate red allergy wristband. This included 2 patients who had previously experienced anaphylaxis as a result of their drug allergy. Finally, comparing the data from the time period with the pharmacy technician, to without a pharmacy technician, demonstrated an almost 10-fold increase in pharmacist prescribing activity. This service evaluation has demonstrated the significant positive impact of a pharmacy technician within the ED. The data collected for this service evaluation was limited as it was only collected on weekdays, and further work should be done to assess the impact of a 7 day service. It is therefore recommended that permanent funding is secured all year round for ED pharmacy technician support, ideally 7 days per week. This will increase medicines reconciliation activity allowing ED pharmacists to focus on clinical review and prescribing for patients, increasing the number of patients seen by pharmacy, allowing earlier identification of patients on critical medicines, reducing the number of missed doses and potential harm. A pharmacy technician also allows earlier confirmation of patients’ allergy status, further reducing harm within the ED. 1. NICE Guideline (NG5). Medicines Optimisation: the safe and effective use of medicines to enable the best possible outcomes. Published 4th March 2015.","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139204921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial Point Prevalence Survey in four Emergency Departments at Manchester University NHS Foundation Trust","authors":"F. M. Garraghan","doi":"10.1093/ijpp/riad074.026","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.026","url":null,"abstract":"Antimicrobial Point Prevalence Surveys (PPS) are a recognised tool to facilitate monitoring of compliance to an organisation’s antimicrobial stewardship (AMS) programme.1 Most PPS tools used within secondary care focus on prescribing of antimicrobials for in-patients. At Manchester University NHS Foundation Trust (MFT) PPS are carried out by clinical pharmacists across all inpatient ward areas. Antimicrobials are one of the most prescribed medicines in the emergency department2 (ED) yet, the current MFT PPS tool does not facilitate undertaking PPS in EDs. A new validated outpatient PPS tool3 from the Global Point Prevalence Survey (GPPS) was released earlier this year. To pilot the GPPS outpatient tool in the EDs at MFT to determine the level of compliance with the MFT antimicrobial guidelines within the EDs, estimate the total burden of antimicrobial use and describe types of infections and prescribed antimicrobials within the EDs. Following the GPPS outpatient protocol3 the four emergency departments (3 general EDs, and 1 paediatric ED) at MFT were assessed in a ten-day period during May 2023. Each ED was assessed continuously for a 4-hour timeslot on a weekday morning by an AMS pharmacist who retrieved the data from the EPIC electronic patient record system remotely. All patients who were allocated a room/bedspace on ED within the timeslot were audited, including patients who were not prescribed antimicrobials. Guideline compliance was checked with the MFT antimicrobial guidelines. The online GPPS data collection tool was used, generating a data download into an Excel spreadsheet for analysis. This study was a service evaluation and so did not require ethical approval. 180 patients were audited from 4 EDs yielding a total of 41 prescriptions for antimicrobials. 28/180 patients were prescribed one or more antimicrobial, with an overall antimicrobial prescribing rate of 15.5%. Prescribing was higher in the paediatric ED with a rate of 25%. 92.7% (38/41) of antimicrobials were prescribed intravenously (IV). Choice of antimicrobial was compliant in 38/41 (92.7%). Dose was compliant in 40/41 (97.6%). Duration of treatment was compliant in 39/41 (95.1%). Sepsis accounted for 48.8% of indications. 2/41 prescriptions were based on the C Reactive Protein (CRP) biomarker. Whilst the study was only conducted over a short time period, the findings suggested that overall compliance with the MFT antimicrobial guidelines was very good. The prescribing rate of 15.5% was low in comparison to the recent MFT inpatient PPS which showed a prescribing rate of 30%. There is a high rate of diagnosis of sepsis and prescribing of IV antimicrobials in comparison to orals which may be anticipated in the emergency setting. The GPPS outpatient audit tool provided an opportunity to do a baseline assessment within the EDs across MFT, providing data on prevalence of antimicrobial prescribing and compliance to the MFT guidelines. The GPPS audit to","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139197889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative analysis of patients’ experiences of taking medication for secondary prevention of acute myocardial infarction","authors":"H. Piekarz, P. Donyai","doi":"10.1093/ijpp/riad074.053","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.053","url":null,"abstract":"Following an acute myocardial infarction, patients are given a daily regime of five medications to prevent secondary cardiovascular events. However, adherence to these medications has been measured to be 66%1. Sub-optimal adherence leads to increased mortality, morbidity and associated healthcare system costs. There is a lack of qualitative research of this experience for these patients, and current interventions, such as Dossett trays and New Medicines Service interviews are based upon presumed difficulties, such as memory and physical medication issues. The aim of this study was to better understand patient’s experience of taking medication to prevent a further AMI, using a narrative analysis framework to describe their relationship with their medication and healthcare professionals. Following ethical approval (UREC 18/36), participants were recruited with inclusion criteria of adults taking medication following at least one previous episode of AMI. Following signed informed consent, semi-structured interviews were conducted with fifteen people from central and southern England. Interviews were conducted in person, online, or on the telephone and audio recorded. The recordings were transcribed verbatim and organised using NVivo software. A narrative analysis framework was used to organise themes within the whole of each participant’s story and then separated into narrative arcs and organised by theme2. The whole story analysis showed the differences between each participant’s story, and that each participant’s story contained varying complicating factors that were personal and specifically important to their lives. The presence of side effects was a complicating factor for most participants. The narrative arc analysis showed that initially, participants felt they began taking medication with little control, feeling compelled to follow their prescriber’s directions and ‘do what they were told’. They understood the benefit to their health, and quickly built routine into their lives. At the next stage, participants worked in collaboration with their prescriber. They had acquired knowledge and social support of non-prescribing professionals, which enabled them to recognise side effects, which they tolerated. Missed doses were viewed as insignificant, happening infrequently and balanced by a history of medication continuity. A crisis point was reached when side effects became unmanageable, where they sought help from their prescriber to change their medication. The desired stage to reach was stability, where participants continued to take medication, and found it simple, unnoticed, fitted into their life and monitored using biometric results. These participants were non-intentional non-adherers, and described how they successfully added a medication regime into their lives, the details of which could assist patients who find this process more difficult. They described personal and detailed stories, indicating that inter","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and GP perceptions of reviewing patients at risk of harm from opioids","authors":"M. Wilcock, M. Motta, L. Trevena","doi":"10.1093/ijpp/riad074.067","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.067","url":null,"abstract":"The Clinical Commissioning Group (CCG) Medicines Optimisation workplan for 2021-22 had a focus on reducing harm from opioids.1,2 In particular, asking GP practices to identify and review two cohorts of patients: those on a combination of oxycodone and amitriptyline or similar high-risk combinations, and those over the age of 65 prescribed fentanyl transdermal patches. Practices were then expected to consider actions on how to reduce the risk for patients and also to provide feedback to the CCG on how the reviews had progressed. We aimed to understand the outcomes, challenges and learning points experienced by practices in reviewing these patients. Sixty practices were invited to participate. A feedback form was received from each practice that completed either or both reviews (covering anonymised outcomes of each review, challenges encountered, and practice-level learning points / changes made). Quantitative data were collated for each action, and feedback comments were categorised into broad groups. No patient details were collected. As this project was a service evaluation, ethical approval was not required. Forty-three practices completed the review of the combination of oxycodone and amitriptyline, though 5 of these had no patients to review. Overall, 185 patients were identified. Of these, 21 (11%) patients had the combination prescribing ceased, 22 (12%) were commenced on a reduction plan, and another 46 (25%) have been made aware of the risk and to report respiratory symptoms. Forty-three practices completed the fentanyl review, though one of these had no patients to review. Overall, 272 patients over 65 years were identified with 64 (24%) invited for a review with their GP or other allied health professional, 39 (14%) patients were put on a fentanyl patch dose reduction plan, and 14 (5%) had prescribing ceased. Practices reported various difficulties encountered with these reviews, including patient engagement in making changes to their pain medication which patients are reluctant to reduce; counselling and raising awareness of long-term effects of opioids to help gain patient understanding; how to manage complex patients who had been stable on their regimen over many years; and that it was time consuming to regularly check in with the patient and plan reduction regimens. Changes made by practices included recording risks discussed with patient in their medical record for easier future review; ensuring regular reviews, including by practice-based pharmacists, of patients prescribed opioids; trying to make time to see patients face to face; raising awareness of the risks of prescribing amitriptyline alongside oxycodone e.g. serotonin syndrome; and recognising that a collaborative process and patient engagement is necessary. The actions undertaken by practices link into national recommendations,1 with some GP feedback similar to the challenges and opportunities to improve patient safety on opioid use as reported","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139202588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“I wasn’t interested until I actually had that consultation”: Exploring the acceptability of a community pharmacy-based hypertension visualisation intervention","authors":"S. Brown, I. Khan, P. Angel, B. Hallingberg, D. McRae, B. McDonnell, D. H. James","doi":"10.1093/ijpp/riad074.013","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.013","url":null,"abstract":"Hypertension affects around 30% of the UK population and is the leading modifiable cause of cardiovascular disease1. Despite available evidence-based treatments, nonadherence to antihypertensive medication is prevalent. Health psychology theory suggests that beliefs about a condition and its treatment influence health-related behaviours such as medication adherence through the formation of ‘illness representations’, a lay perception of the health threat. Accurate illness representations and an increased belief in the necessity for medication are associated with greater medication adherence2. Visualisation of the internal process of an illness has been shown to support the accuracy of illness representations3. ViSTA-BP (Visualisation to Support Treatment Adherence for High Blood Pressure) is a digital intervention used within a healthcare consultation, enabling individuals to visualise and conceptualise hypertension and the resulting changes to the circulatory system using real-time animations. The purpose is to support medication adherence through the improved understanding of hypertension and increased perception of medication necessity. To explore the acceptability of a community pharmacy-based hypertension visualisation intervention (ViSTA-BP) with community pharmacists and patients. Acceptability of ViSTA-BP was investigated in a community pharmacy setting in South Wales by conducting semi-structured qualitative interviews with pharmacists and patients. Ethical approval was granted by NHS Research Ethics Committee Wales (REC) 5 (20/WA/0280) and Cardiff Metropolitan University Ethics Committee (PGR-3806). Template analysis, a form of qualitative thematic analysis, was used to guide data interpretation. The Theoretical Framework of Acceptability (TFA) provided a lens through which to investigate acceptability, considering affective attitude towards the intervention burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness and self-efficacy. Patients were purposely selected, incorporating a range of locations, adherence and treatment beliefs, thus minimising bias. Interviews were conducted with fifteen patients and eight pharmacists who provided feedback. Both groups demonstrated a positive attitude towards ViSTA-BP. Patients were both interested in and reassured by the intervention. They showed good intervention coherence, articulating an increased understanding of hypertension and suggesting patient groups that could benefit from ViSTA-BP. Pharmacists felt ViSTA-BP illustrated the necessity for medication, demonstrating that hypertension could be managed effectively. Patients and pharmacists were positive about ViSTA-BP’s potential for effectiveness. Patients felt it provided context for their understanding of hypertension and could prompt action. Pharmacists liked the visual elements, with ViSTA-BP providing a useful addition to their consultation ‘toolkit’. Patients felt that ViSTA-BP fit","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An innovative method to identify educational need regarding depression and anxiety as an under-recognised side effect of anti-TNF medicines","authors":"D. Rosembert, F. Eldridge, T. Raine, A. St Clair-Jones","doi":"10.1093/ijpp/riad074.059","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.059","url":null,"abstract":"Depression and anxiety (D&A) in chronic autoimmune conditions such as Inflammatory Bowel Disease (IBD), Rheumatoid arthritis (RA), Psoriatic arthritis (PsA), and Psoriasis (PsO) is common, with patients twice as likely to suffer from it.1 Biologic medicines are increasingly used in autoimmune conditions and are prescribed only by secondary care. Patients initiated on biologic medicines, specifically anti-TNF, can report depression and anxiety as related side effects listed as common in the summary of product characteristics2,3 and may not get investigated for this side effect when visiting GP practices and hospital reviews. This could lead to unnecessary use of psychological or psychopharmacological treatment and a poor patient experience of biologics therapies. To explore healthcare professionals’ understanding of the potential adverse effects of anti-TNF medicines including D&A symptoms in patients who present to primary care. A Twitter poll was used on the social media platform Twitter to raise the question; ‘GP’s, practice nurses and pharmacists, if your patient with IBD, RA, PsA, PsO etc. presents with symptoms of depression, do you check if they are prescribed a hospital only biologic such as anti-TNF (depression listed as a common side effect) as a possible cause?’. The Likert scale, Always, Sometimes, Never, Didn’t occur to me was used to elicit answers. The question was open for a 3 day window in May 2021, and then repeated in February 2022. A national webinar (advertised for anyone to attend) was held to present these results, and two further questions were asked of the participants using Slido; ‘are you surprised at this figure of 60%?’ and ‘do you think that something needs to be done about this?’ with a yes or no response option. Ethical approval was not required for this service evaluation. The results from the Twitter poll in May 2021, had 38 votes, the summary of the responses were 2(5%) [Always], 5 (13%) [Sometimes], 8 (21%) [Never] and 23 (61%) [Didn’t occur to me]. Results from the second poll in February 2022 had 217 votes and responses were 27(12%) [Always], 33(15%) [Sometimes], 23(10%) [Never] and 134(63%) [Didn’t occur to me]. Of the 150 people who attended the webinar, 99 (66%) were not surprised and 100% thought something needs to be done about it. This innovative if not scientific method (Twitter and Slido) of surveying HCPs, identified a considerable lack of awareness of the D&A side effects of biologics and uncovered a gap in monitoring of vulnerable patients. This suggests the need for education of HCPs about this issue. Awareness can also be increased through patient education, appropriate counselling, and patient information leaflets. Empowering patients to ask if the hospital prescribed medication is on their GP medication list and a potential cause. Twitter is a novel way to gain insight from colleagues, however responses from HCPs only are not guaranteed. This approach is a model to sc","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139197272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the causes of preventable medication incidents for patients with mental illness in primary care","authors":"M. J. Ayre, P. J. Lewis, D. L. Phipps, R. N. Keers","doi":"10.1093/ijpp/riad074.008","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.008","url":null,"abstract":"A recent scoping review has highlighted that whilst patients with mental illness are commonly affected by medication errors and preventable adverse drug events in primary care, there were limited data regarding their causes1. By understanding why these preventable events occur, targeted interventions can be developed. To understand the nature and contributory factors that lead to medication errors and preventable adverse drug events amongst patients with mental illness in primary care. This study used a qualitative design. A researcher remotely interviewed 26 healthcare professionals (14 pharmacists, 5 GPs, 5 nurses, 2 psychiatrists) working in primary care between June-November 2022, guided by the critical incident technique. Professionals were recruited via social media, research team networks, and snowballing. Data were analysed using the framework method and any data that involved speculation as to the causes of errors was not included. The data were organised into themes based on the London protocol error framework, which describes the contributory factors leading to care delivery problems2. Themes generated were validated by other members of the research team and a patient advisory group. This study was approved by the University of Manchester Ethics Committee 1 (reference 2022-13735-23555). Forty-three medication errors and twelve preventable adverse drug events were discussed during interview. Prescribing errors were discussed most commonly (n=24) and administration errors least commonly (n=4). Six contributory factors were identified which were: the individual (staff) (n=37); the work environment (n=31); the teams/interfaces (n=28); the organisation and management (n=24); the patient (n=23); and the task and technology (n=15). Primary care clinicians reported a lack of knowledge regarding psychotropics and mental illness which accompanied diffusion of responsibility. The responsibilities of staff were also confused by limited clinical information communicated between teams and across care interfaces. Service demand was reported to exceed capacity, creating stress for the staff, as well as limiting the time available for staff to undergo training. Complicated patient lifestyles and behavioural challenges were reported as unique contributory factors. Lack of knowledge amongst primary care clinicians regarding psychotropics and mental illness was a key issue. This was exacerbated by a mental health service structure placing considerable pressure on primary care leaving clinicians to support patients with needs perceived to be outside their areas of confidence and competence. There is a need to support this workforce by upskilling them to effectively manage patients by addressing the educational needs regarding neuropharmacology and communication skills. These changes may have a positive effect in reducing error rates for this patient group in primary care. Study limitations include recall bias, social desirabilit","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and feasibility study of a community pharmacy intervention to support self-management of patients with type 2 diabetes, in Cyprus","authors":"A. Pavlidou, F. Smith, C. Whittlesea","doi":"10.1093/ijpp/riad074.052","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.052","url":null,"abstract":"The pharmacists’ role has evolved over the past years towards a more clinical role to support patients in managing various prevalent health conditions.1 Cyprus had one of the highest prevalence of diabetes among other European countries in 2021.2 Motivational interviewing has been shown to be an effective tool in consultations.3 In recent years there has been increasing interest in the potential of mobile technologies in health care. However, effective implementation, management, and evaluation of those interventions aiming to improve type 2 diabetes self-management are still being researched. The aim of this study was to design and implement a mobile health intervention delivered by a pharmacist applying motivational interviewing techniques, aiming to improve the self-management of type 2 diabetes patients. Then, assess primarily the feasibility and acceptability of the interventions and, secondarily, the participants' medication adherence and self-care activity. Type 2 diabetes patients visiting a diabetes clinic in Cyprus were recruited. The intervention included: online communication with the pharmacist, tracking & uploading blood glucose readings, graphical reports, reminders, education, and optimization of pharmacotherapy delivered over an initial face-to-face consultation and up to 3 follow-up telephone appointments at 6-8 weeks intervals. Feasibility was measured by recruitment & retention, use & workability of the intervention, and basic costs. Participants’ & healthcare professionals’ acceptability was assessed via two semi-structured interview schedules based on the Theoretical Framework of Acceptability (Sekhon et al., 2017). Participants’ medication adherence and self-care activity were assessed by Diabetes Self-Care Activities Questionnaire - Greek version before and after the intervention. The study obtained ethical approval from the Cyprus National Bioethics Committee (27/11/2019, reference number EEBK ΕΠ 2019.01.202), the Cyprus Ethics Committee (05/04/2020, reference number 01/20) and the UCL Research Ethics Committee (28/04/2020, reference number Z6364106/2020/04/129). Twenty-seven patients agreed to participate, of whom 22 completed the intervention. From the available services, all participants agreed to use online communication, chose education, and the review of patients’ medications. A barrier to the intervention was the pharmacist accessing patients’ data, as HbA1c was accessible in 69% of participants and blood glucose in 90%. Based on study findings, participants valued the motivational interview and pharmacist approach, while healthcare professionals highlighted the benefits of pharmacy service, specifically medication adherence. Participants reported improvements in self-care during the study period in three out of five domains assessed in the DSCAQ– Greek version (blood sugar testing, healthy eating, and foot care), whereas adherence to diabetes medications and physical activity remained the same","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139199949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the boundaries of ward-based services – exploring the scope of “non-traditional” clinical pharmacy practice in a tertiary referral teaching hospital","authors":"C. Cheng","doi":"10.1093/ijpp/riad074.016","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.016","url":null,"abstract":"Hospital clinical pharmacy practice in the UK has developed beyond traditional boundaries of ward-based inpatient services. Royal Pharmaceutical Society Hospital Pharmacy Standards recommend pharmacy team members are integrated into multidisciplinary teams across the organisation to ensure safe and appropriate medicines use whatever the setting1. Pharmacy professionals provide pharmaceutical care and specialist services in outpatient and ambulatory settings and through participation in multidisciplinary team (MDT) meetings. Within the outpatient setting, research typically focusses on single outpatient clinics within specific disciplines, little evidence describes the overall contribution to patient care across whole pharmacy services2. To describe the scope of clinical pharmacy services occurring beyond traditional ward-based services in a tertiary hospital; including quantification of outpatient clinics and MDT meetings provided by pharmacy professionals. The Deputy Chief Pharmacist invited clinical Principal Pharmacists to participate in semi-structured interviews exploring the scope of “non-traditional” services across the Trust during March 2023. Non-traditional services were defined as direct clinical care outside of ward-based inpatient clinical pharmacy services. Indirect clinical care activities such as guideline writing, drug expenditure and governance activities were excluded. Inpatient board rounds/ward rounds and any service not currently provided due to vacancy were excluded. Participants were asked to quantify services provided, advise who provided the services and to describe contributions provided by the pharmacy team. The study was deemed service evaluation and ethical approval waived. 100% invited pharmacists participated. Pharmacists attended and contributed to over 150 MDT meetings monthly across 24 sub-specialities; 80% were for outpatients. In tertiary/quaternary services, these frequently covered patients beyond local geography. MDT meetings were typically attended by specialist, principal or consultant pharmacists. Common contributions included: provision of pro-active advice/responding to queries; medicines optimisation; monitoring; income or compliance assurance; prescribing/deprescribing. Specialist pharmacists provided 80-100 outpatient clinic sessions across 17 sub-specialities through a mix of face-to-face and virtual appointments, advanced pharmacy technicians provided on-treatment and counselling clinics. Activities included: initiation, monitoring, adjustment and cessation of medicines; patient counselling and MDT referral. Medicines prescribed were typically high cost, complex and higher risk. Pharmacists prescribed and clinically verified homecare medicines and provided ongoing annual review of outpatient medicines, including prescribing/deprescribing. Teams described medicines reconciliation and counselling in ambulatory haematology settings, off-site units and infusion suites. The team or","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139205162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}