A cross-sectional survey of the access of older people in the Scottish Highlands to general medical practices, community pharmacies and prescription medicines

Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review

BACKGROUND

Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions' mechanisms of action and are more likely to result in effective and sustained interventions.

AIM

To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research.

METHOD

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed.

RESULTS

Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework).

CONCLUSION

This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development.

Pharmacy location and medical need: regional evidence from Canada

Background

Pharmacists in Canada are assuming an increasingly important role in the provision of primary care services. This raises questions about access to pharmacy services among those with medical care needs. While there is evidence on proximity of residents of Ontario and Nova Scotia to community pharmacies, there is little evidence for the rest of Canada. I thus measured the availability of pharmacist services, both the number of community pharmacies and their hours of operation, at both the provincial and sub-provincial level in Canada. Next, I measured associations of indicators of medical need and the availability of pharmacist services across sub-provincial units.

Methods

I collected data, for each Forward Sortation Area (FSA), on medical need, measured using the fraction of residents aged 65 + and median household income, and pharmacist service availability (the number of community pharmacies and their hours of operation, divided by the FSA population). Linear regression methods were used to assess associations of FSA-level service availability and medical need.

Results

There are between 2.0 and 3.3 community pharmacies per 10,000 population, depending on the province. There are also provincial variations in the number of hours that pharmacies are open. Quebec pharmacies were open a median of 75 h a week. In Manitoba, pharmacies were open a median of 53 h a week. The per capita number of pharmacies and their total hours of operation at the FSA level tend to be higher in less affluent regions and in which the share of residents is aged 65 or older. Provincial differences in pharmacy availability were still evident after controlling for medical need.

Conclusion

Community pharmacies in Canada tend to locate where indicators of health needs are greatest. The impact on patient health outcomes of these pharmacy locational patterns remains an area for future research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08709-5.

Geographical accessibility of medicines: a systematic literature review of pharmacy mapping

BACKGROUND

Measuring access to medicines has often been limited to assessing availability and affordability, while little is known regarding other dimensions of access including geographical accessibility. Our study aims to provide a systematic review of literature on the accessibility of medicines by studying the geographical distribution of pharmacies using Spatial Analytical methods.

METHODS

As systematic review of scientific peer-reviewed literature between 2000 and 2018 was carried out using PubMed, Web of Science, Google Scholar, Google and the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). Data regarding pharmacy density, distance to pharmacies in relation of pharmacy to sociodemographic factors and pharmacy characteristics were extracted from studies that meet the inclusion criteria.

FINDINGS

Twenty papers fulfilled our inclusion criteria, of which only three were from middle income countries and rest from high-income economies. Pharmacy density per population was reported in 15 studies. Although geographical information was utilized in all studies, only 14 studies reported distance to pharmacies represented as Euclidean (straight line) distance. Disparities in accessibility was reported according to population income and rural or urban location. Seven studies described additional pharmacy characteristics including opening hours, presence of a pharmacist and delivery services.

CONCLUSIONS

Geographical accessibility is a key dimension of access to medicines. Pharmacy density per population is a relevant indicator to assess geographical accessibility which should be complemented by an equity analysis using socio-demographic information and population perception of accessibility.

Turkish community pharmacists' behavioral determinants in provision of pharmaceutical care to elderly patients

Background It is crucial to develop and implement community pharmacist-led pharmaceutical care services in primary care that could prevent and detect potentially inappropriate prescribing and promote medication adherence in older patients. Objective The aim of this study was to determine community pharmacists' perceived barriers and facilitators face during the provision of pharmaceutical care to older patients by using a theoretical domains framework. Method A cross-sectional online survey was conducted among community pharmacists in Turkey. A Turkish version of the 50-item Determinants of Implementation Behavior Questionnaire was developed to evaluate behavioral determinants of community pharmacists on delivering pharmaceutical care to older patients. Main outcome measures The behavioral determinants of community pharmacists. Results A total of 354 community pharmacists answered the questionnaire. The mean age was 43.2 (standard deviation = 11.1), and 227 (64%) of the pharmacists were female. Community pharmacists' positive opinions on pharmaceutical care service outcomes in older patients and feedback were regarded as facilitators. Community pharmacists' motivational level and emotions were additional determinant facilitators in delivering pharmaceutical care to older patients. Their negative opinions on the impact and action of pharmaceutical care in older patients were regarded as barriers. Conclusion In primary health care, a theory-based e-distant training program for community pharmacists and the guidelines for standard pharmaceutical care services led by community pharmacists could be designed by addressing barriers related to the impact and action of pharmaceutical care in older patients.

External Loop Recorders: Primary Care Placement Is Noninferior to Hospital-Based Cardiac Unit

Introduction: External loop recorders (ELRs) are recommended for the investigation of syncope and palpitations. This study aimed to compare rates of arrhythmia detection between primary care (PC) and hospital-based cardiac unit (HBCU) fitted ELRs. Methods: Data were captured from January to December 2015. Twenty-eight general practitioner practices and 1 hospital took part. Patients were divided into those with ELR fitted in PC or HBCU. All ELR data were analyzed by a cardiac physiologist. Results: A total of 560 ELR recordings were analyzed; 219 (PC) versus 341 (HBCU). There was no difference between the baseline characteristics (all Ps > .05). The predominant indication for ELR in each group were palpitations; between-group variation was observed for syncope (P = .0004). There were no significant between-group differences in the number of recordings per patient; however, PC group wore the ELR for less time (median 7 days vs median 14 days; P < .0001). There were no differences in arrhythmia detection between PC- and HBCU-fitted ELRs (16.2% [n = 39] vs 21.7% [n = 74], respectively; P = .28). PC placement of ELRs was highest in very remote rural communities (P = .005) and correlated with distance from HBCU (r = 0.39; P = .04). Conclusions: This study showed no difference in detection of arrhythmias between PC and HBCU fitted ELRs. This suggests adequate ELR recording can be completed by suitably trained staff in PC. Furthermore, ELRs were fitted for less time in PC without an adverse effect on diagnostic yield. ELR usage increased with increasing distance from the specialist center and rurality suggesting improved local access to arrhythmia detection services.

Prescribers' perceptions of benefits and limitations of direct acting oral anticoagulants in non-valvular atrial fibrillation

Background:

There is an acknowledged lack of robust and rigorous research focusing on the perspectives of those prescribing direct acting oral anticoagulants (DOACs) for non-valvular atrial fibrillation (AF).

Objective:

The objective was to describe prescribers’ experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations.

Methods:

A cross-sectional survey of prescribers in a remote and rural area of Scotland. Among other items, the questionnaire invited free-text description of positive and negative experiences of DOACs, and benefits and limitations. Responses were independently analysed by two researchers using a summative content analysis approach. This involved counting and comparison, via keywords and content, followed by interpretation and coding of the underlying context into themes.

Results:

One hundred and fifty-four responses were received, 120 (77.9%) from physicians, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 unidentified professions). Not having to monitor INR was the most cited benefit, particularly for prescribers and patients in remote and rural settings, followed by potentially improved patient adherence. These benefits were reflected in respondents’ descriptions of positive experiences and patient feedback. The main limitations were the lack of reversal agents, cost and inability to monitor anticoagulation status. Many described their experiences of adverse effects of DOACs including fatal and non-fatal bleeding, and upper gastrointestinal disturbances.

Conclusions:

While prescribers have positive experiences and perceive benefits of DOACs, issues such as adverse effects and inability to monitor anticoagulation status merit further monitoring and investigation. These issues are particularly relevant given the trajectory of increased prescribing of DOACs.

A cross-sectional survey of the perspectives of older people in the Scottish Highlands on the management of their chronic pain

BACKGROUND

Although there is evidence of suboptimal outcomes in older people with chronic pain, little emphasis has been placed on those in remote and rural settings.

OBJECTIVE

To describe the perspectives of older people in the Scottish Highlands on their chronic pain management.

DESIGN

Cross-sectional survey.

SETTING

NHS Highland, the most remote and rural geographical health board in Scotland.

SUBJECTS

Home-dwelling members of the public aged ≥70 years.

METHODS

Anonymised questionnaires were mailed to a random sample of 1800 older people. Questionnaire items were demographics, nature of any chronic pain, management regimens and perceived effectiveness. Validated scales were the Pain Disability Questionnaire and the Tampa Scale for Kinesiophobia.

RESULTS

Adjusted response rate was 39.3% (709/1755). One-quarter (25.0%, n = 177) were experiencing chronic pain, being more likely to live in deprived areas (P < 0.05). Median pain intensity was 6 (IQR 4-7, 10 high), causing distress (median 5, IQR 3-7). Respondents largely consulted GPs (66.1%, n = 117) with a minority (16.4%, n = 29) referred to a specialist pain clinic and few consulting other health professionals. Over three quarters (78.0%, n = 138) were receiving prescribed medicines, most commonly paracetamol, alone (35.6%, n = 63) or in combination with opioids (16.4%, n = 29). One-third (31.6%, n = 56) expressed a desire for more effective medicines; few reported using any non-pharmacological therapies. The median scores for the Pain Disability Questionnaire and Tampa Scale for Kinesiophobia were 74 (IQR 34-104.5, 150 high) and 40 (IQR 35-45, 68 high).

CONCLUSIONS

Evidence of provision of appropriate integrated and person-centred chronic pain care is lacking.

Geographic disparities in accessing community pharmacies among vulnerable populations in the Greater Toronto Area

OBJECTIVES

Geographic accessibility to community pharmacies (CPs) plays an increasingly important role for the well-being of a community. This study examines the geographic distribution of CPs within the Greater Toronto Area (GTA) relative to the residential patterns of vulnerable populations, including older adults (65+ years), infants and children (0-9 years), and low-income households.

METHODS

The study develops a geographic accessibility index at a dissemination area (DA) level by employing the enhanced two-step floating catchment area (E2SFCA) method to measure geographic accessibility to pharmacies. A vulnerability index is also developed to assess and visualize the residential patterns of vulnerable groups. A combined vulnerability-accessibility index is then constructed to identify low-access areas associated with high levels of socio-economic vulnerability. A range of geo-referenced datasets are analyzed within a geographical information system.

RESULTS

The study reveals geographical disparities in accessing pharmacies between urban and suburban areas and across different neighbourhoods, while accounting for population density and distance decay. About 19% of the population (or 15% of DAs) are under-serviced, with very poor geographic access to CPs (1.7 CPs per 10,000 persons), compared to 29.6% of the DAs that are well-/over-serviced, with an average score of 2.8 CPs per 10,000 persons.

CONCLUSION

The spatial-quantitative analysis at a small geography (DA) allows for improved accuracy for identifying specific neighbourhoods that are in need of greater access to pharmacies by vulnerable residents and areas that have an excessive supply of pharmacies. It provides implications for addressing barriers to accessing pharmacies among high-needs groups, including the rapidly growing older adult population in the GTA.

A qualitative study of the perspectives of older people in remote Scotland on accessibility to healthcare, medicines and medicines-taking

Background Recent evidence highlights the disproportionate rates of health inequality often experienced within remote and rural communities. Access to medicines within remote and rural communities may also prove problematic. Objective The aim was to understand the perspectives of older people in the most remote areas of the Scottish Highlands on issues of accessibility to healthcare, medicines and medicines-taking. Method Qualitative, semi-structured one-to-one interviews with 13 residents aged 65 years and over in the most remote and rural areas of the Scottish Highlands. Interviews were audio-recorded, transcribed and analysed using a framework approach. Setting Remote and rural areas in the Scottish Highlands. Participants had previously completed a cross-sectional survey. Main outcome measure Themes surrounding the perspectives of older people in the most remote areas of the Scottish Highlands on issues of accessibility to healthcare, medicines and medicines-taking. Results Healthcare was considered convenient, and positive relationships with providers being important. Review of medicines was perceived to be the remit of the doctor, with pharmacists seen as valuable suppliers of medicines. Conclusion Based on this qualitative study, experiences of access to healthcare, including community pharmacy, medicines and medicines-taking within this sample of older adults resident in the most remote areas of the Scottish Highlands are widely variable. There may be an unmet educational need, amongst residents, with regard to awareness of the role of pharmacists, the services they can provide and the benefits which may be experienced as a consequence of engagement.