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Szkodny D, Wróblewska-Czajka E, Stryja M, Gara F, Wylęgała E. A Web Application for Reporting Eye Donors: Idea, Development and Doctor's Opinion. Transplant Proc 2023; 55:2003-2008. [PMID: 37863668 DOI: 10.1016/j.transproceed.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Obtaining corneas in a country of 38 million, Poland, is extremely inefficient. In Poland, about 1000 corneas are transplanted annually, of which over 500 come from multi-organ donations. To our knowledge, such a low percentage of donations is in the absence of reporting of potential corneal donors. There is no computer system in our country for tissue donor reporting. The aim of the work is to present an innovative application developed for this purpose. MATERIAL AND METHODS It was a cross-sectional, observational study. The questionnaires were collected from doctors who had access to the app. RESULTS Almost all participants (47/52) answered that they would use this app if it was available in the hospital, 46 acknowledged that the application could encourage doctors to report tissue donors, and 48 confirmed it should be integrated with the IT system of hospitals and should be available in all of them. CONCLUSION Despite advances in medicine and technology and increased awareness of organ donation and transplantation, the gap between supply and demand is constantly growing. Due to the large number of patients awaiting corneal transplants in Poland, it is necessary to introduce changes aimed at improving this situation. The newly developed app may contribute to increasing donor reporting.
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Affiliation(s)
- Dominika Szkodny
- Clinical Department of Ophthalmology Faculty of Medical Sciences, Zabrze Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, District Railway Hospital in Katowice, Katowice, Poland.
| | - Ewa Wróblewska-Czajka
- Clinical Department of Ophthalmology Faculty of Medical Sciences, Zabrze Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, District Railway Hospital in Katowice, Katowice, Poland
| | | | - Filip Gara
- Artnovation sp. z o.o., 44-100 Gliwice, Poland
| | - Edward Wylęgała
- Clinical Department of Ophthalmology Faculty of Medical Sciences, Zabrze Medical University of Silesia in Katowice, Katowice, Poland; Department of Ophthalmology, District Railway Hospital in Katowice, Katowice, Poland
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Jeffries M, Salema NE, Laing L, Shamsuddin A, Sheikh A, Avery T, Chuter A, Waring J, Keers RN. Using sociotechnical theory to understand medication safety work in primary care and prescribers' use of clinical decision support: a qualitative study. BMJ Open 2023; 13:e068798. [PMID: 37105697 PMCID: PMC10151989 DOI: 10.1136/bmjopen-2022-068798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES The concept of safety work draws attention to the intentional work of ensuring safety within care systems. Clinical decision support (CDS) has been designed to enhance medication safety in primary care by providing decision-making support to prescribers. Sociotechnical theory understands that healthcare settings are complex and dynamically connected systems of fluid networks, human agents, changing relationships and social processes. This study aimed to understand the relationship between safety work and the use of CDS. DESIGN AND SETTING This qualitative study took place across nine different general practices in England. Stakeholders included general practitioners (GPs) and general practice-based pharmacists and nurse prescribers. Semi-structured interviews were conducted to illicit how the system was used by the participants in the context of medication safety work. Data analysis conducted alongside data collection was thematic and drew on socio-technical theory. PARTICIPANTS Twenty-three interviews were conducted with 14 GPs, three nurse prescribers and three practice pharmacists between February 2018 and June 2020. RESULTS Safety work was contextually situated in a complex network of relationships. Three interconnected themes were interpreted from the data: (1) the use of CDS within organisational and social practices and workflows; (2) safety work and the use of CDS within the interplay between prescribers, patients and populations; and (3) the affordances embedded in CDS systems. CONCLUSION The use of sociotechnical theory here extends current thinking in patient safety particularly in the ways that safety work was co-constituted with the use of CDS alerts. This has implications for implementation and use to ensure that the contexts into which such CDS systems are implemented are taken into account. Understanding how alerts can adapt safety culture will help improve the efficacy of CDS systems, enhance prescribing safety and help to further understand how safety work is achieved in primary care.
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Affiliation(s)
- Mark Jeffries
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Nde-Eshimuni Salema
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Libby Laing
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Aziz Sheikh
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Tony Avery
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Antony Chuter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Justin Waring
- School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Richard Neil Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Sauchelli S, Pickles T, Voinescu A, Choi H, Sherlock B, Zhang J, Colyer S, Grant S, Sundari S, Lasseter G. Public attitudes towards the use of novel technologies in their future healthcare: a UK survey. BMC Med Inform Decis Mak 2023; 23:38. [PMID: 36814262 PMCID: PMC9944774 DOI: 10.1186/s12911-023-02118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Innovation in healthcare technologies can result in more convenient and effective treatment that is less costly, but a persistent challenge to widespread adoption in health and social care is end user acceptability. The purpose of this study was to capture UK public opinions and attitudes to novel healthcare technologies (NHTs), and to better understand the factors that contribute to acceptance and future use. METHODS An online survey was distributed to the UK public between April and May 2020. Respondents received brief information about four novel healthcare technologies (NHTs) in development: a laser-based tool for early diagnosis of osteoarthritis, a virtual reality tool to support diabetes self-management, a non-invasive continuous glucose monitor using microwave signals, a mobile app for patient reported monitoring of rheumatoid arthritis. They were queried on their general familiarity and attitudes to technology, and their willingness to accept each NHT in their future care. Responses were analysed using summary statistics and content analysis. RESULTS Knowledge about NHTs was diverse, with respondents being more aware about the health applications of mobile apps (66%), followed by laser-based technology (63.8%), microwave signalling (28%), and virtual reality (18.3%). Increasing age and the presence of a self-reported medical condition favoured acceptability for some NHTs, whereas self-reported understanding of how the NHT works resulted in elevated acceptance scores across all NHTs presented. Common contributors to hesitancy were safety and risks from use. Respondents wanted more information and evidence to help inform their decisions, ideally provided verbally by a general practitioner or health professional. Other concerns, such as privacy, were NHT-specific but equally important in decision-making. CONCLUSIONS Early insight into the knowledge and preconceptions of the public about NHTs in development can assist their design and prospectively mitigate obstacles to acceptance and adoption.
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Affiliation(s)
- Sarah Sauchelli
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
| | - Tim Pickles
- grid.5600.30000 0001 0807 5670Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Alexandra Voinescu
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, UK
| | - Heungjae Choi
- grid.5600.30000 0001 0807 5670School of Engineering, Cardiff University, Cardiff, UK
| | - Ben Sherlock
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jingjing Zhang
- grid.8356.80000 0001 0942 6946Department of Mathematical Sciences, University of Essex, Colchester, UK
| | - Steffi Colyer
- grid.7340.00000 0001 2162 1699Department of Health, University of Bath, Bath, UK
| | - Sabrina Grant
- grid.5337.20000 0004 1936 7603Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sethu Sundari
- grid.189530.60000 0001 0679 8269School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | - Gemma Lasseter
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in Collaboration with UK Health Security Agency (UKHSA), Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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de Aguiar Pontes Pamplona Y, do Nascimento AMV, de Olinda RA, Barbieri CLA, Braga ALF, Martins LC. Spatial analysis of measles vaccination coverage in the State of São Paulo. BMC Public Health 2023; 23:29. [PMID: 36604709 PMCID: PMC9815067 DOI: 10.1186/s12889-022-14797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Measles is a contagious viral disease that seriously affects children. The measles vaccine is widely recommended in Brazil and in the world; however, the disease remains relevant for the health authorities. The aim of the present study was to evaluate first and second dose of measles vaccine coverage (VC) in the cities of São Paulo and its spatial dynamics between 2015 and 2020. METHOD In this mixed-type ecological study, we used secondary, public domain data from 2015 to 2020, extracted from the Digital Information System of the National Immunization Program, Mortality Information System and the National Live Birth Information System. After calculating the VC, the following four categories were created: very low, low, adequate, and high, and the spatial autocorrelation of VC was analyzed using the Global and Local Moran's statistics. RESULTS A steady decline in adherence to the vaccination was observed, which dynamically worsened until 2020, with a high number of cities fitting the classification of ineffective coverage and being potentially harmful to the effectiveness of the immunization activities of their neighbors. CONCLUSION A direct neighborhood pattern was observed between the units with low vaccination coverage, which implied that the reduction in measles VC was somehow related to and negatively influenced by the geographic location and social culture of these areas.
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Affiliation(s)
- Ysabely de Aguiar Pontes Pamplona
- Catholic University of Santos (Universidade Católica de Santos - Programa de Pós-Graduação strictu senso em Saúde Coletiva), Av. Conselheiro Nebias, 300, Sala 106, São Paulo, Santos, CEP: 11.015-002, Brazil
| | | | | | - Carolina Luisa Alves Barbieri
- Catholic University of Santos (Universidade Católica de Santos - Programa de Pós-Graduação strictu senso em Saúde Coletiva), Av. Conselheiro Nebias, 300, Sala 106, São Paulo, Santos, CEP: 11.015-002, Brazil
| | - Alfésio Luís Ferreira Braga
- Catholic University of Santos (Universidade Católica de Santos - Programa de Pós-Graduação strictu senso em Saúde Coletiva), Av. Conselheiro Nebias, 300, Sala 106, São Paulo, Santos, CEP: 11.015-002, Brazil
| | - Lourdes Conceição Martins
- Catholic University of Santos (Universidade Católica de Santos - Programa de Pós-Graduação strictu senso em Saúde Coletiva), Av. Conselheiro Nebias, 300, Sala 106, São Paulo, Santos, CEP: 11.015-002, Brazil.
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Seguin M, Mendoza J, Lasco G, Palileo-Villanueva LM, Palafox B, Renedo A, McKee M, Balabanova D. Strong structuration analysis of patterns of adherence to hypertension medication. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531298 PMCID: PMC9748305 DOI: 10.1016/j.ssmqr.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
Achieving blood pressure control is among the highest priorities for reducing the burden of cardiovascular diseases globally. Control is poor in the Philippines, especially in socioeconomically marginalised communities. This paper explores long-term adherence to anti-hypertensive medication in these communities, identifying 4 distinct medication adherence patterns. We draw on Strong Structuration Theory to explore motivations of action for those who are consistently adherent, consistently non-adherent, and those who became more or less adherent over time. We employ longitudinal qualitative methods comprising repeat interviews and digital diaries collected over 12 months by 34 participants. Twelve participants were consistently adherent, 9 consistently non-adherent, 9 increasingly adherent, and 4 increasingly non-adherent. For the consistently adherent, positive views about prescribed medication and family support encouraged adherence. Conversely, negative views of medication and lack of family support were notable amongst the consistently non-adherent, along with resistance to accepting a 'sick' label. A shift toward positive views of medication was detected amongst those whose adherence improved, along with worsening health and increased family support. A decrease in financial resources drove some participants to become less adherent, especially if they already held negative views toward medication. This study sheds light on the variety of medication adherence patterns among poor people with hypertension in the Philippines, as well as the complex web of elements influencing their treatment choices. The results point to the potential for measures that address concerns about medicines and increase family support.
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Affiliation(s)
- Maureen Seguin
- The Centre for Global Chronic Conditions, The London School of Hygiene and Tropical Medicine, UK
| | - Jhaki Mendoza
- College of Medicine, University of the Philippines Manila, Philippines
| | - Gideon Lasco
- Development Studies Program, Ateneo de Manila University, Philippines.,Department of Anthropology, University of the Philippines Diliman, Philippines
| | | | - Benjamin Palafox
- The Centre for Global Chronic Conditions, The London School of Hygiene and Tropical Medicine, UK
| | - Alicia Renedo
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, UK
| | - Martin McKee
- The Centre for Global Chronic Conditions, The London School of Hygiene and Tropical Medicine, UK
| | - Dina Balabanova
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, UK
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Sibuyi IN, de la Harpe R, Nyasulu P. A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case. JMIR Mhealth Uhealth 2022; 10:e18188. [PMID: 35708756 PMCID: PMC9247812 DOI: 10.2196/18188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/02/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background
The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector’s benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies.
Objective
This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa.
Methods
This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies.
Results
Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government’s MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth.
Conclusions
This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa.
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Affiliation(s)
- Idon-Nkhenso Sibuyi
- Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Retha de la Harpe
- Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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Tsang JY, Peek N, Buchan I, van der Veer SN, Brown B. OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:1106-1119. [PMID: 35271724 PMCID: PMC9093027 DOI: 10.1093/jamia/ocac031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/08/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives (1) Systematically review the literature on computerized audit and feedback (e-A&F) systems in healthcare. (2) Compare features of current systems against e-A&F best practices. (3) Generate hypotheses on how e-A&F systems may impact patient care and outcomes. Methods We searched MEDLINE (Ovid), EMBASE (Ovid), and CINAHL (Ebsco) databases to December 31, 2020. Two reviewers independently performed selection, extraction, and quality appraisal (Mixed Methods Appraisal Tool). System features were compared with 18 best practices derived from Clinical Performance Feedback Intervention Theory. We then used realist concepts to generate hypotheses on mechanisms of e-A&F impact. Results are reported in accordance with the PRISMA statement. Results Our search yielded 4301 unique articles. We included 88 studies evaluating 65 e-A&F systems, spanning a diverse range of clinical areas, including medical, surgical, general practice, etc. Systems adopted a median of 8 best practices (interquartile range 6–10), with 32 systems providing near real-time feedback data and 20 systems incorporating action planning. High-confidence hypotheses suggested that favorable e-A&F systems prompted specific actions, particularly enabled by timely and role-specific feedback (including patient lists and individual performance data) and embedded action plans, in order to improve system usage, care quality, and patient outcomes. Conclusions e-A&F systems continue to be developed for many clinical applications. Yet, several systems still lack basic features recommended by best practice, such as timely feedback and action planning. Systems should focus on actionability, by providing real-time data for feedback that is specific to user roles, with embedded action plans. Protocol Registration PROSPERO CRD42016048695.
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Affiliation(s)
- Jung Yin Tsang
- Corresponding Author: Jung Yin Tsang, Centre for Primary Care and Health Services Research, University of Manchester, 6th Floor Williamson Building, Oxford Road, Manchester M13 9PL, UK;
| | - Niels Peek
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GMPSTRC), University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, UK
| | - Iain Buchan
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Benjamin Brown
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GMPSTRC), University of Manchester, Manchester, UK
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Jeffries M, Keers RN, Belither H, Sanders C, Gallacher K, Alqenae F, Ashcroft DM. Understanding the implementation, impact and sustainable use of an electronic pharmacy referral service at hospital discharge: A qualitative evaluation from a sociotechnical perspective. PLoS One 2021; 16:e0261153. [PMID: 34936661 PMCID: PMC8694480 DOI: 10.1371/journal.pone.0261153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient’s medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service Methods We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory. Results Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient. Conclusions By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service.
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Affiliation(s)
- Mark Jeffries
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- * E-mail:
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Division of Population Health, Health Services Research & Primary Care University of Manchester, Manchester, United Kingdom
| | - Kay Gallacher
- Patient and Public Involvement, NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Fatema Alqenae
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
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Kennedy A, O'Gorman C, Lee K. Have your cake and eat it? Combining structure and agency in management research. EUROPEAN MANAGEMENT REVIEW 2021. [DOI: 10.1111/emre.12490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aileen Kennedy
- Office 3‐052.2, School of Marketing, College of Business Technological University Dublin (TU Dublin) Dublin Ireland
| | - Colm O'Gorman
- Q324, DCU Business School Dublin City University, Glasnevin campus Dublin 9 Ireland
| | - Kenneth Lee
- Department of Accounting The London School of Economics and Political Science London UK
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The implementation, use and sustainability of a clinical decision support system for medication optimisation in primary care: A qualitative evaluation. PLoS One 2021; 16:e0250946. [PMID: 33939750 PMCID: PMC8092789 DOI: 10.1371/journal.pone.0250946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background The quality and safety of prescribing in general practice is important, Clinical decision support (CDS) systems can be used which present alerts to health professionals when prescribing in order to identify patients at risk of potentially hazardous prescribing. It is known that such computerised alerts may improve the safety of prescribing in hospitals but their implementation and sustainable use in general practice is less well understood. We aimed to understand the factors that influenced the successful implementation and sustained use in primary care of a CDS system. Methods Participants were purposively recruited from Clinical Commissioning Groups (CCGs) and general practices in the North West and East Midlands regions of England and from the CDS developers. We conducted face-to-face and telephone-based semi-structured qualitative interviews with staff stakeholders. A selection of participants was interviewed longitudinally to explore the further sustainability 1–2 years after implementation of the CDS system. The analysis, informed by Normalisation Process Theory (NPT), was thematic, iterative and conducted alongside data collection. Results Thirty-nine interviews were conducted either individually or in groups, with 33 stakeholders, including 11 follow-up interviews. Eight themes were interpreted in alignment with the four NPT constructs: Coherence (The purpose of the CDS: Enhancing medication safety and improving cost effectiveness; Relationship of users to the technology; Engagement and communication between different stakeholders); Cognitive Participation (Management of the profile of alerts); Collective Action (Prescribing in general practice, patient and population characteristics and engagement with patients; Knowledge);and Reflexive Monitoring (Sustaining the use of the CDS through maintenance and customisation; Learning and behaviour change. Participants saw that the CDS could have a role in enhancing medication safety and in the quality of care. Engagement through communication and support for local primary care providers and management leaders was considered important for successful implementation. Management of prescribing alert profiles for general practices was a dynamic process evolving over time. At regional management levels, work was required to adapt, and modify the system to optimise its use in practice and fulfil local priorities. Contextual factors, including patient and population characteristics, could impact upon the decision-making processes of prescribers influencing the response to alerts. The CDS could operate as a knowledge base allowing prescribers access to evidence-based information that they otherwise would not have. Conclusions This qualitative evaluation utilised NPT to understand the implementation, use and sustainability of a widely deployed CDS system offering prescribing alerts in general practice. The system was understood as having a role in medication safety in providing relevant patient specific information to prescribers in a timely manner. Engagement between stakeholders was considered important for the intervention in ensuring prescribers continued to utilise its functionality. Sustained implementation might be enhanced by careful profile management of the suite of alerts in the system. Our findings suggest that the use and sustainability of the CDS was related to prescribers’ perceptions of the relevance of alerts. Shared understanding of the purpose of the CDS between CCGS and general practices particularly in balancing cost saving and safety messages could be beneficial.
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Mbakaya BC, Kalembo FW, Zgambo M. Use, adoption, and effectiveness of tippy-tap handwashing station in promoting hand hygiene practices in resource-limited settings: a systematic review. BMC Public Health 2020; 20:1005. [PMID: 32586314 PMCID: PMC7316639 DOI: 10.1186/s12889-020-09101-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/12/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tippy-taps are locally made devices for washing hands with running water. They are simple and low-cost, enabling technology that provides adequate water sources, handwashing stations and motivation for people to prioritise handwashing. This systematic review aimed to establish the use, benefits, adoption and effectiveness of enabling technology; tippy-tap handwashing station, in resource-limited settings. METHODS We systematically searched for articles in the PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases guided by the acceptable best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles. Search terms such as tippy-taps, enabling technology, hand-washing station, hand-washing behaviour, diarrhoea, respiratory infection, increase handwashing behaviour were used. In addition, a PRISMA flow diagram was used to elaborate on the number of articles retrieved, retained, excluded and reasons for every action. Studies that used tippy-tap hand washing station as a handwashing facility regardless of the design were included in this review. A mixed method appraisal tool was used to appraise studies. RESULTS Twenty articles met the eligibility criteria. The use of tippy-taps for handwashing by household members or school children was reported by authors of 16 studies, and it ranged from 2.7 to 80%. The availability of tippy-taps increased handwashing and use of soap among participants. Furthermore, the majority of people who were oriented to tippy-taps or recruited to tippy-tap studies built their tippy-tap stations even after the promotional activities or programs had ended. In one study, tippy-taps were reported by participant to be effective in preventing episodes of stomach pain among participants. CONCLUSION Tippy-tap handwashing station could help in promoting handwashing practice in resource constraint settings. Future studies are needed to evaluate the effectiveness of tippy-tap hand washing station on preventing water and hygiene-related infections.
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Affiliation(s)
| | | | - Maggie Zgambo
- St John's Institute for Health, P.O. Box 18, Mzuzu, Malawi
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12
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Panes G, Round J, Snelgrove S, Storey M, Hughes D. Nurse-led medicines' monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study. PLoS One 2019; 14:e0220885. [PMID: 31509537 PMCID: PMC6738583 DOI: 10.1371/journal.pone.0220885] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Preventable adverse effects of medicines often pass unnoticed, but lead to real harm. Intervention Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines. Objectives This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice. Methods Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales. Results Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation. Implications To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Timothy Banner
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Cardiff and Vale University Health Board, Wales, United Kingdom
| | | | - Jane M. Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Hywel Dda University Health Board, Wales, United Kingdom
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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Yera A, Muguerza J, Arbelaitz O, Perona I, Keers RN, Ashcroft DM, Williams R, Peek N, Jay C, Vigo M. Modelling the interactive behaviour of users with a medication safety dashboard in a primary care setting. Int J Med Inform 2019; 129:395-403. [PMID: 31445283 DOI: 10.1016/j.ijmedinf.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/24/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To characterise the use of an electronic medication safety dashboard by exploring and contrasting interactions from primary users (i.e. pharmacists) who were leading the intervention and secondary users (i.e. non-pharmacist staff) who used the dashboard to engage in safe prescribing practices. MATERIALS AND METHODS We conducted a 10-month observational study in which 35 health professionals used an instrumented medication safety dashboard for audit and feedback purposes in clinical practice as part of a wider intervention study. We modelled user interaction by computing features representing exploration and dwell time through user interface events that were logged on a remote database. We applied supervised learning algorithms to classify primary against secondary users. RESULTS We observed values for accuracy above 0.8, indicating that 80% of the time we were able to distinguish a primary user from a secondary user. In particular, the Multilayer Perceptron (MLP) yielded the highest values of precision (0.88), recall (0.86) and F-measure (0.86). The behaviour of primary users was distinctive in that they spent less time between mouse clicks (lower dwell time) on the screens showing the overview of the practice and trends. Secondary users exhibited a higher dwell time and more visual search activity (higher exploration) on the screens displaying patients at risk and visualisations. DISCUSSION AND CONCLUSION We were able to distinguish the interactive behaviour of primary and secondary users of a medication safety dashboard in primary care using timestamped mouse events. Primary users were more competent on population health monitoring activities, while secondary users struggled on activities involving a detailed breakdown of the safety of patients. Informed by these findings, we propose workflows that group these activities and adaptive nudges to increase user engagement.
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Affiliation(s)
- Ainhoa Yera
- Faculty of Informatics, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Spain
| | - Javier Muguerza
- Faculty of Informatics, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Spain
| | - Olatz Arbelaitz
- Faculty of Informatics, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Spain
| | - Iñigo Perona
- Faculty of Informatics, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Spain
| | - Richard N Keers
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Richard Williams
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Niels Peek
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Caroline Jay
- School of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Markel Vigo
- School of Computer Science, University of Manchester, Manchester, United Kingdom.
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14
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Thomsen EL, Khoury LR, Møller T, Boisen KA. Parents to chronically ill adolescents have ambivalent views on confidential youth consultations - a mixed methods study. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0226/ijamh-2018-0226.xml. [PMID: 31026223 DOI: 10.1515/ijamh-2018-0226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Confidential youth consultations aiming at enhancing adolescent autonomy are a cornerstone of transitional care. At the same time, parental support is essential. These conflicting considerations result in a clinical dilemma. OBJECTIVE The aim of this study was to examine the attitudes of parents to chronically ill adolescents regarding confidential youth consultations and to explore the underlying reasons. METHODS A sequential explanatory mixed methods design consisting of a cross-sectional questionnaire survey (n = 117) and three focus group interviews among parents (n = 12) to chronically ill adolescents (12-19 years) was used. Quantitative data were analyzed descriptively. Qualitative data were analyzed using King's template method. RESULTS The parents preferred independent youth consultations starting around the age of 14-15 years. Around 60% of the parents had one or more concerns regarding independent youth consultations. Although 64% of the parents supported conditional or full confidentiality during adolescence, 95% wanted information even though their child did not consent. In the qualitative analysis, the parents described caring for a child with chronic disease as a term of life perceiving themselves as an "octopus" with numerous roles related to daily care and treatment and at the same time with thoughts and worries regarding the future. We found four themes: 'a life with chronic disease', 'responsibility', 'protection' and 'apprenticeship'. The parents' attitudes were influenced by their roles and their perception of the adolescent's competences as well as their experience with the healthcare system. CONCLUSIONS Our findings suggest that parents need transitional care too.
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Affiliation(s)
- Ena L Thomsen
- Center of Adolescent Medicine, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lina R Khoury
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Jeffries M, Keers RN, Phipps DL, Williams R, Brown B, Avery AJ, Peek N, Ashcroft DM. Developing a learning health system: Insights from a qualitative process evaluation of a pharmacist-led electronic audit and feedback intervention to improve medication safety in primary care. PLoS One 2018; 13:e0205419. [PMID: 30365508 PMCID: PMC6203246 DOI: 10.1371/journal.pone.0205419] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Developments in information technology offer opportunities to enhance medication safety in primary care. We evaluated the implementation and adoption of a complex pharmacist-led intervention involving the use of an electronic audit and feedback surveillance dashboard to identify patients potentially at risk of hazardous prescribing or monitoring of medicines in general practices. The intervention aimed to create a rapid learning health system for medication safety in primary care. This study aimed to explore how the intervention was implemented, adopted and embedded into practice using a qualitative process evaluation. METHODS Twenty two participants were purposively recruited from eighteen out of forty-three general practices receiving the intervention as well as clinical commissioning group staff across Salford UK, which reflected the range of contexts in which the intervention was implemented. Interviews explored how pharmacists and GP staff implemented the intervention and how this affected care practice. Data analysis was thematic with emerging themes developed into coding frameworks based on Normalisation Process Theory (NPT). RESULTS Engagement with the dashboard involved a process of sense-making in which pharmacists considered it added value to their work. The intervention helped to build respect, improve trust and develop relationships between pharmacists and GPs. Collaboration and communication between pharmacists and clinicians was primarily initiated by pharmacists and was important for establishing the intervention. The intervention operated as a rapid learning health system as it allowed for the evidence in the dashboard to be translated into changes in work practices and into transformations in care. CONCLUSIONS Our study highlighted the importance of the combined use of information technology and the role of pharmacists working in general practice settings. Medicine optimisation activities in primary care may be enhanced by the implementation of a pharmacist-led electronic audit and feedback system. This intervention established a rapid learning health system that swiftly translated data from electronic health records into changes in practice to improve patient care. Using NPT provided valuable insights into the ways in which developing relationships, collaborations and communication between health professionals could lead to the implementation, adoption and sustainability of the intervention.
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Affiliation(s)
- Mark Jeffries
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Denham L. Phipps
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Richard Williams
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Health eResearch Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Benjamin Brown
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Health eResearch Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anthony J. Avery
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Health eResearch Centre, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
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