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Borg C, Porritt K, Hotham E. Patient, parent/carer, and health care professional experience of medication adherence in children and adolescents with asthma: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:2714-2720. [PMID: 33009105 DOI: 10.11124/jbisrir-d-18-00026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This systematic review aims to identify and synthesize available qualitative evidence related to patient, parent/carer, and health care professional experiences of medication adherence in children and adolescents with asthma. INTRODUCTION Poor medication adherence is a common cause of treatment failure in children with asthma. Research into promoting treatment adherence has found that the most effective interventions are complex. In a child with asthma, the child, the parents/carers, and the health care professional all have important roles in adhering to medication regimens. This review aims to explore the experiences of the patient, parent/carer, and health care professional in managing a child's asthma. INCLUSION CRITERIA This review will consider children and adolescents between the ages of three and 19 years with asthma, as well as the parent/carer and health care professionals who care for a child with asthma. Qualitative studies exploring the experiences of adherence or nonadherence to asthma medication will be included. METHODS A three-stage search will be conducted and will include published and gray literature. Databases to be searched include CINAHL, Embase, PubMed, PyscINFO, Scopus, and Web of Science. Only studies published in English will be considered, with no date limitation. Identified studies will be screened for inclusion by two independent reviewers. Data will be extracted using a standardized tool, and reviewers will discuss any disagreement. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be applied as evidence-based practice.
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Affiliation(s)
- Corey Borg
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Kylie Porritt
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Elizabeth Hotham
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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Peláez S, Bacon SL, Lacoste G, Lavoie KL. How can adherence to asthma medication be enhanced? Triangulation of key asthma stakeholders' perspectives. J Asthma 2016; 53:1076-84. [PMID: 27167629 DOI: 10.3109/02770903.2016.1165696] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Adherence to daily asthma controller medication has been shown to be the most effective component of asthma self-management; however, patient's adherence to asthma medication remains poor. This study aimed to understand how patients' long-term asthma controller medication adherence may be improved and facilitated by comparing key asthma stakeholders' perspectives. METHOD Six focus group interviews including 38 asthma stakeholders (n = 13 patients, n = 13 pulmonologist physicians, and n = 12 allied healthcare professionals) were conducted. Interviews were qualitatively analysed. RESULTS Although similar themes were brought up across different asthma stakeholders, the way in which they were framed differed across stakeholders. The most salient discussion revolved around the content and the moment in which asthma education should be approached to facilitate patients' adherence to asthma medication. CONCLUSION Asthma medication adherence is a complex process and successful interventions aimed at its improvement would benefit from: (a) making an effort to understand patients' experiences and negotiate the treatment regimen, rather than imposing recommendations; (b) considering treatment as a shared responsibility involving the patient, the healthcare professional(s), and the patients' social networks; and,
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Affiliation(s)
- Sandra Peláez
- a Montreal Behavioural Medicine Centre (MBMC), Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal , Montréal , Québec , Canada
| | - Simon L Bacon
- a Montreal Behavioural Medicine Centre (MBMC), Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal , Montréal , Québec , Canada
| | - Guillaume Lacoste
- a Montreal Behavioural Medicine Centre (MBMC), Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal , Montréal , Québec , Canada
| | - Kim L Lavoie
- a Montreal Behavioural Medicine Centre (MBMC), Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal , Montréal , Québec , Canada
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Corrao G, Arfè A, Nicotra F, Ghirardi A, Vaghi A, De Marco R, Pesci A, Merlino L, Zambon A. Persistence with inhaled corticosteroids reduces the risk of exacerbation among adults with asthma: A real-world investigation. Respirology 2016; 21:1034-40. [PMID: 27061430 DOI: 10.1111/resp.12791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Real-world evidence suggests that persistence with inhaled corticosteroids (ICS), the mainstay of asthma drug therapy, is generally poor. The effect of persistence with ICS on the risk of asthma exacerbation was addressed in a population-based study. METHODS The cohort of 2335 beneficiaries of the National Health Service provided by the Italian Region of Lombardy, aged 18-40 years and newly treated with ICS during 2005-2008, was followed from their first ICS dispensation until 2010. Discontinuation of treatment with ICS and starting oral corticosteroid therapy during follow-up were respectively regarded as proxies of poor persistence with asthma medication and asthma exacerbation (outcomes). A proportional hazards model was fitted to identify predictors of ICS discontinuation. Case-crossover and case-case-time-control designs and conditional logistic regressions were used to estimate the association between persistence with ICS and asthma exacerbation. RESULTS Cumulative incidences of discontinuation were 36%, 57% and 78% at 6 months, 1 year and 5 years, respectively. Predictors of poor persistence were female gender, use of antibiotics during follow-up, absence of use of short-acting beta-agonists prior to and after starting treatment with ICS and starting and maintaining ICS monotherapy during follow-up. The odds ratios of asthma exacerbation (and 95% confidence intervals) associated with ICS exposure during the current period, contrasted with exposure during the reference period, were 0.4 (0.2, 0.9) and 0.3 (0.1, 1.0) from case-crossover and case-case-time-control estimates, respectively. CONCLUSION Persistence with ICS treatment in adults with asthma reduces the risk of exacerbation in the real-life setting.
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Affiliation(s)
- Giovanni Corrao
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Andrea Arfè
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federica Nicotra
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Arianna Ghirardi
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Adriano Vaghi
- Division of Pneumology, "Guido Salvini" Hospital, Garbagnate Milanese, Italy
| | - Roberto De Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Alberto Pesci
- Department of Health Science, University of Milano-Bicocca, Milan, Italy.,Respiratory Unit, "San Gerardo" Hospital, Monza, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Elaro A, Shah S, Armour CL, Bosnic-Anticevich S. A snapshot of pharmacist attitudes and behaviors surrounding the management of pediatric asthma. J Asthma 2015; 52:957-68. [PMID: 26291141 DOI: 10.3109/02770903.2015.1020387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study is to identify the current status of pediatric asthma management in the Australian community pharmacy setting from the pharmacists' perspective. This research will allow us to identify training needs of community pharmacists. METHOD Pharmacists were recruited from the Sydney metropolitan region and asked to complete a self-reported questionnaire that elucidated information on four general domains relating to pediatric asthma management within community pharmacy. All data collected were analysed descriptively. Bivariate Pearson correlations were performed to determine whether interrelationships existed between specific domains. RESULTS All 77 pharmacists completed the questionnaire. Thirty-two percent had not completed any asthma related CPD in the past year and only 25% of pharmacists reported using the national asthma guidelines in practice. Just over half of the pharmacists (54%) reported that they provide device technique demonstrations for new inhaled medicines, and 35% of pharmacists reported that they check for written asthma self-management plan possession. Although 65% of pharmacists reported confidence in communication skills, most pharmacists were not confident in setting short-/long-term goals with the patient and carer for managing asthma at home. Pharmacists believed that they are just as effective as doctors in providing asthma counseling and education. Lack of time was identified as a significant barrier. CONCLUSION We have identified a gap between guideline recommended practices and the self-reported practices of community pharmacists. Pharmacists need more appropriate continuing education programs that can translate into improved pediatric asthma self-management practices and thus improved asthma outcomes in children. This may require an alternative approach.
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Affiliation(s)
- Amanda Elaro
- a Woolcock Institute of Medical Research, University of Sydney , NSW , Australia
| | - Smita Shah
- b Primary Health Care Education and Research Unit, Primary and Community Health Network, Sydney West Area Health Service , Sydney , NSW , Australia .,c Sydney Medical School, University of Sydney , Sydney , NSW , Australia , and
| | - Carol L Armour
- a Woolcock Institute of Medical Research, University of Sydney , NSW , Australia .,d Sydney Local Health District , Sydney , NSW , Australia
| | - Sinthia Bosnic-Anticevich
- a Woolcock Institute of Medical Research, University of Sydney , NSW , Australia .,d Sydney Local Health District , Sydney , NSW , Australia
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Peláez S, Lamontagne AJ, Collin J, Gauthier A, Grad RM, Blais L, Lavoie KL, Bacon SL, Ernst P, Guay H, McKinney ML, Ducharme FM. Patients' perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy. BMC Pulm Med 2015; 15:42. [PMID: 25907709 PMCID: PMC4429418 DOI: 10.1186/s12890-015-0044-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients’ insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions. Methods We conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients’ perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach. Results Patients were aged 2–76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility. Conclusions We identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients’ adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0044-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Peláez
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Alexandrine J Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Johanne Collin
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
| | - Annie Gauthier
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Roland M Grad
- Department of Family Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Lucie Blais
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
| | - Kim L Lavoie
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
| | - Simon L Bacon
- Department of Exercise Sciences, Concordia University, Montreal, Quebec, Canada.
| | - Pierre Ernst
- Department of Pulmonary Medicine, Jewish General Hospital, Montreal, Quebec, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Hélène Guay
- Institut national d'excellence en santé et en services sociaux, Quebec, Quebec, Canada.
| | - Martha L McKinney
- Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada.
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. .,Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada. .,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. .,Departments of Pediatrics and of Social and Preventive Medicine, Associate Director of Clinical Research, Research Centre, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7939, Montreal, Quebec, H3T 1C5, Canada.
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PACE: Pharmacists use the power of communication in paediatric asthma. Int J Clin Pharm 2014; 36:976-85. [PMID: 25087038 DOI: 10.1007/s11096-014-9984-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paediatric asthma is a public health burden in Australia despite the availability of national asthma guidelines. Community pharmacy interventions focusing on paediatric asthma are scarce. Practitioner Asthma Communication and Education (PACE) is an evidence-based program, developed in the USA for general practice physicians, aimed at addressing the issues of poor clinician-patient communication in the management of paediatric asthma. This program has been shown to improve paediatric asthma management practices of general practitioners in the USA and Australia. The development of a PACE program for community pharmacists will fill a void in the current armamentarium for pharmacist-patient care. OBJECTIVES To adapt the educational program, PACE, to the community pharmacy setting. To test the feasibility of the new program for pharmacy and to explore its potential impact on pharmacists' communication skills and asthma related practices. SETTING Community pharmacies located within the Sydney metropolitan. METHOD The PACE framework was reviewed by the research team and amended in order to ensure its relevance within the pharmacy context, thereby developing PACE for Pharmacy. Forty-four pharmacists were recruited and trained in small groups in the PACE for Pharmacy workshops. Pharmacists' satisfaction and acceptability of the workshops, confidence in using communication strategies pre- and post-workshop and self-reported behaviour change post workshop were evaluated. MAIN OUTCOME MEASURE Pharmacist self-reported changes in communication and teaching behaviours during a paediatric asthma consultation. RESULTS All 44 pharmacists attended both workshops, completed pre- and post-workshop questionnaires and provided feedback on the workshops (100 % retention). The participants reported a high level of satisfaction and valued the interactive nature of the workshops. Following the PACE for Pharmacy program, pharmacists reported significantly higher levels in using the communication strategies, confidence in their application and their helpfulness. Pharmacists checked for written asthma self-management plan possession and inhaler device technique more regularly, and provided verbal instructions more frequently to paediatric asthma patients/carers at the initiation of a new medication. CONCLUSION This study provides preliminary evidence that the PACE program can be translated into community pharmacy. PACE for Pharmacy positively affected self-reported communication and education behaviours of pharmacists. The high response rate shows that pharmacists are eager to expand on their clinical role in primary healthcare.
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Grover C, Goel N, Chugh K, Gaur SN, Armour C, van Asperen PP, Moles RJ, Saini B. Medication use in Indian children with asthma: the user's perspective. Respirology 2014; 18:807-13. [PMID: 23489243 DOI: 10.1111/resp.12081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/14/2012] [Accepted: 12/20/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite the high prevalence of asthma in children, there has been limited research into patient perception of medication use, particularly in the developing world. This study therefore aimed to carry out an in-depth exploration of the views of carers and children with asthma on asthma medication use. METHODS Grounded theory approach was used to conduct semistructured qualitative interviews in a purposive convenience sample of parents and children with asthma. The participants were recruited from two specialty hospitals in New Delhi, India. Interviews were tape-recorded, transcribed verbatim and thematically analysed. RESULTS Twenty children (7-12 years old) with asthma and their parent or carer were interviewed in July 2011. Major reported issues included poor parent and child understanding of disease and medications. Fears, misinformed beliefs and lack of self-management skills were apparent. Child self-image, resistance to medication use and lack of responsibility in medication taking were themes that emerged from child interviews. CONCLUSIONS This is one of the first research studies exploring the viewpoint of children with asthma about their medications. Resource constraints dictate a pragmatic paternalistic approach by physicians which, in contrast to patients in westernized nations, seems to be acceptable and satisfactory to Indian patients (carers).
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Grover C, Armour C, Van Asperen PP, Moles RJ, Saini B. Medication use in Australian children with asthma: user's perspective. J Asthma 2013; 50:231-41. [PMID: 23305726 DOI: 10.3109/02770903.2012.757778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Medication use-related issues remain problematic in childhood asthma despite effective treatment strategies and public investment into improved asthma management strategies in industrialized countries. This study aimed to carry out an in-depth exploration of the views of parents/carers and children with asthma on medication use. METHODS Semi-structured qualitative interviews were conducted with a purposive convenience sample of children with asthma and their parents recruited from general practices in Sydney. Interviews were tape-recorded, transcribed verbatim, and thematically analyzed. RESULTS A total of 52 interviews (26 parents/carers and 26 children with asthma) were conducted. Major themes which emerged from the children's interviews included issues such as self-image, resistance to medication use, and lack of responsibility in medication taking. Parental or carer issues included lack of clear understanding of how medications worked, as well as administration difficulties, cost constraints, and beliefs about medications contrary to quality use. DISCUSSION This is one of the few research studies exploring the viewpoint of children with asthma about their medications in Australia. Despite investment in dissemination of professional, targeted evidence-based asthma management strategies in healthcare, there seems to be a lack of depth in terms of what parents understand about their child's asthma. Effective communication about medication usage, especially the inclusion of the child in the consultation to empower them to be involved in their own asthma care, may be the answer.
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Affiliation(s)
- Charu Grover
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
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Grover C, Armour C, Asperen PPV, Moles R, Saini B. Medication use in children with asthma: not a child size problem. J Asthma 2011; 48:1085-103. [PMID: 22013989 DOI: 10.3109/02770903.2011.624234] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. METHODS A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted. RESULTS The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. CONCLUSION These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.
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Affiliation(s)
- Charu Grover
- Faculty of Pharmacy, University of Sydney, Camperdown Campus, Sydney, New South Wales, Australia
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