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Hetherington MM, Thomas JM, McLeod CJ. "I see it very much as an end-of-life food" - Barriers to oral nutritional supplement adherence, views from healthy older adults. Appetite 2024; 197:107327. [PMID: 38555018 DOI: 10.1016/j.appet.2024.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Malnutrition affects approximately one quarter of UK adults aged 65 years and over. As the global demographic shift continues, malnutrition is expected to increase. Oral nutritional supplements (ONS) are used both to prevent and to treat malnutrition. However, their effectiveness is compromised by poor adherence, and it is not well understood what contributes to this. Therefore, the current research was designed to explore ONS adherence from the parallel perspectives of ONS as a prescribed "medication" and as a food supplement/substitute. Eighteen older adults (13F, 5M; mean age = 73.4 yr; range: 70-80 yr) participated in focus groups (three in-person and one online), to investigate experiences of taking prescribed medications, including dietary supplements, and what should be factors to consider in supporting regular intake of ONS for trial development, as well as any potential improvements to products. Focus group sessions were recorded and then transcribed. Thematic Analysis was applied to the transcripts by the first author, and themes were discussed in depth, using exemplar quotes from participants. Five dominant themes were identified from the data: Disgust, Palatability and Acceptance; End-of-Life Care; Resistance to Medicines; Rituals and Reminders; and Real Food Displacement. Nutritional supplements were characterised as "disgusting", "manufactured", and associated with serious, chronic illness, as well as end-of-life care, in contrast to probiotics which were linked with health and wellness. The sweet taste of ONS was identified as a barrier to intake, given that it is generally associated with a signal to stop eating, and low hunger. As a group, participants tried to "avoid taking medicines", and viewed the need to have them negatively, yet most regularly took prescribed medication and/or vitamin supplements. Participants identified several, rituals and reminders to take medicines, including meal-based, or time-of-day-based prompts (e.g., before, with or after meals). To improve adherence, savoury products were suggested, as well as a more person-centred approach to individual nutritional needs and preferences. Overall, the group discussion mainly identified barriers to intake, but that improving taste, adding to "real food" (not replacing meals), and offering variety of flavour and form (e.g., savoury soups as well as sweet drinks) could be included in future trials to improve appeal and therefore intake. Future work should continue to explore how best to formulate, market and/or prescribe ONS, and how this might vary for malnutrition prevention vs treatment strategies.
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Affiliation(s)
| | - Jason M Thomas
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Chris J McLeod
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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Poots AJ, Jubraj B, Ward E, Wycoco A, Barnett N. Education around medication review and deprescribing: a survey of medical and pharmacy students' perspectives. Ther Adv Drug Saf 2020; 11:2042098620909610. [PMID: 32215198 PMCID: PMC7081458 DOI: 10.1177/2042098620909610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/21/2020] [Indexed: 12/18/2022] Open
Abstract
Research into the practice of medication review is developing across the world in response to the ever-increasing burden of inappropriate polypharmacy. Education, training and support of undergraduates and novice practitioners to equip them to participate in the medication review process could lead to long-term shifts in practice. The purpose of this study was to explore the awareness of pharmacy and medical undergraduates about medication review, deprescribing and polypharmacy, in order to inform improvement strategies. In November 2016, all final-year medical and pharmacy students at a London (UK) university were invited to complete a short questionnaire survey. Qualitative analysis inductively themed free-text comments and quantitative analysis used descriptive statistics to summarize responses, with chi-square tests used to indicate differences between the groups. The overall response rate was 34% (171/500). The terms ‘medication review’ and ‘polypharmacy’ were known to the students, whilst the term ‘deprescribing’ was unfamiliar with no difference between the groups. The term ‘medication review’ meant different things to the groups: pharmacy students suggested a focus on adherence and patient understanding, whilst medical students focused on interactions and whether medicines were still indicated. The groups differed in their perceptions of who they thought undertook reviews, who identifies potentially inappropriate medicines, who makes the final decision to deprescribe and the frequency of medication reviews. Both groups reported that on qualification they would not be comfortable stopping a medicine without discussion with a senior colleague, but would be comfortable prompting a senior colleague to review. Both groups had some awareness of medication review tools. The meaning of the term ‘medication review’ differed between the student groups. While medical students focused on clinical aspects, pharmacy students emphasized patient experience. Both groups anticipated a lack of confidence in deprescribing without senior support, highlighting the need for alignment between education and professional development syllabi in a way that combines the variety of professional perspectives. Prompts by juniors could lead to more medication reviews within existing practice, and may give them invaluable experience in reviewing medicines in their future careers as seniors.
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Affiliation(s)
| | - Barry Jubraj
- King's College London, London, UK, Medicines Optimization, Collaboration for Leadership in Applied Health Research and Care Northwest London, and Medicines Use and Safety Team, NHS Specialist Pharmacy Service, UK
| | - Emily Ward
- Lead Directorate Pharmacist for Medicine and Research, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | | | - Nina Barnett
- Care of Older People, London North West University Healthcare NHS Trust, and Medicines Use and Safety Team, NHS Specialist Pharmacy Service, Middlesex, UK
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Da Costa DL, Corlett SA, Dodds LJ. A narrative review on the consultation tools available for pharmacists in the United Kingdom: do they facilitate person-centred care? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:301-311. [PMID: 31638309 DOI: 10.1111/ijpp.12587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To identify consultation tools cited in the published literature and undertake a narrative review which establishes their scope to support the delivery of person-centred medicine-focused consultations between community pharmacists and patients in the United Kingdom (UK). KEY FINDINGS Nine consultation tools used in a pharmacy context were identified. Four tools (Calgary-Cambridge guide, MRCF, MUR and NMS advanced services and PaCT) were selected for further appraisal. None of the tools identified provided a suitable format or sufficient guidance to address all components required for the delivery of a person-centred patient consultation in practice. SUMMARY Tools available to UK pharmacists are inadequate for fully supporting delivery of a person-centred consultation in practice. Revision of existing tools or creation of more pharmacy-specific tools will support UK pharmacists' delivery of person-centred consultations in practice.
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Affiliation(s)
- Daniel L Da Costa
- Pharmacy Practice, Medway School of Pharmacy, Universities of Kent & Greenwich, Chatham, UK
| | - Sarah A Corlett
- Pharmacy Practice, Medway School of Pharmacy, Universities of Kent & Greenwich, Chatham, UK
| | - Linda J Dodds
- Pharmacy Practice, Medway School of Pharmacy, Universities of Kent & Greenwich, Chatham, UK
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Costa C, Frampas C, Longman KA, Palitsin V, Ismail M, Sears P, Nilforooshan R, Bailey MJ. Paper spray screening and liquid chromatography/mass spectrometry confirmation for medication adherence testing: A two-step process. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2019; 35:e8553. [PMID: 31414505 PMCID: PMC8047880 DOI: 10.1002/rcm.8553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 05/15/2023]
Abstract
RATIONALE Paper spray offers a rapid screening test without the need for sample preparation. The incomplete extraction of paper spray allows for further testing using more robust, selective and sensitive techniques such as liquid chromatography/mass spectrometry (LC/MS). Here we develop a two-step process of paper spray followed by LC/MS to (1) rapidly screen a large number of samples and (2) confirm any disputed results. This demonstrates the applicability for testing medication adherence from a fingerprint. METHODS Following paper spray analysis, drugs of abuse samples were analysed using LC/MS. All analyses were completed using a Q Exactive™ Plus Orbitrap™ mass spectrometer. This two-step procedure was applied to fingerprints collected from patients on a maintained dose of the antipsychotic drug quetiapine. RESULTS The extraction efficiency of paper spray for two drugs of abuse and metabolites was found to be between 15 and 35% (analyte dependent). For short acquisition times, the extraction efficiency was found to vary between replicates by less than 30%, enabling subsequent analysis by LC/MS. This two-step process was then applied to fingerprints collected from two patients taking the antipsychotic drug quetiapine, which demonstrates how a negative screening result from paper spray can be resolved using LC/MS. CONCLUSIONS We have shown for the first time the sequential analysis of the same sample using paper spray and LC/MS, as well as the detection of an antipsychotic drug from a fingerprint. We propose that this workflow may also be applied to any type of sample compatible with paper spray, and will be especially convenient where only one sample is available for analysis.
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Affiliation(s)
- Catia Costa
- Surrey Ion Beam CentreUniversity of SurreyGuildfordGU2 7XHUK
| | - Cecile Frampas
- Department of ChemistryUniversity of SurreyGuildfordGU2 7XHUK
| | | | | | - Mahado Ismail
- Department of ChemistryUniversity of SurreyGuildfordGU2 7XHUK
| | - Patrick Sears
- Department of ChemistryUniversity of SurreyGuildfordGU2 7XHUK
| | - Ramin Nilforooshan
- Surrey and Borders Partnership Foundation NHS Trust, ACUHolloway HillChertseyKT16 0AEUK
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Jalal Z, Akhtar S, Finlay K, King K, Goel N, Ward J. Perceptions of UK Community Pharmacists on Current Consultation Skills and Motivational Interviewing as a Consultation Approach: A Qualitative Study. PHARMACY 2019; 7:E52. [PMID: 31159294 PMCID: PMC6630739 DOI: 10.3390/pharmacy7020052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Community pharmacists' roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists' views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30-60 minutes in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges.
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Affiliation(s)
- Zahraa Jalal
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Sania Akhtar
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Katherine Finlay
- School of Psychology and Wellbeing, The University of Buckingham, Buckingham, Bucks MK18 1EG, UK.
| | - Kathryn King
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London SE1 8WA, UK.
| | - Neera Goel
- School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Jonathan Ward
- Interactive Studies Unit, University of Birmingham, Birmingham B15 2TT, UK.
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Jones ASK, Fernandez J, Grey A, Petrie KJ. The Impact of 3-D Models versus Animations on Perceptions of Osteoporosis and Treatment Motivation: A Randomised Trial. Ann Behav Med 2018; 51:899-911. [PMID: 28474286 DOI: 10.1007/s12160-017-9913-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Osteoporosis is a degenerative bone disorder that disproportionately affects older women worldwide. Raising awareness regarding osteoporosis within this demographic is significant for health promotion. Initial evidence suggests that visualisations of illness and treatment can improve illness perceptions, increase treatment motivations and even promote health behaviours. We are yet to understand whether different visualisation mediums vary in their impact on perceptions and motivations. PURPOSE We investigated whether physical models or virtual animations had a greater impact on changing perceptions of osteoporosis and treatment motivation in an at-risk population of older women. METHODS A total of 128 women aged 50 and over were randomly assigned to view a brief presentation about osteoporosis using either 3-D printed bone models or electronic tablet animations. Illness perceptions, medication beliefs and motivations were measured at baseline and post-presentation. Mixed ANOVAs were used to identify significant changes over time between groups. RESULTS There were no significant interaction effects, revealing that neither medium had a greater impact on beliefs over time. Significant main effects of time revealed that from baseline to post-presentation, both mediums increased consequence beliefs, personal and treatment control, understanding of osteoporosis, motivations to take treatment if needed and medication necessity beliefs. Timeline beliefs and medication concerns decreased over time for both groups. CONCLUSIONS Both 3-D models and animations of osteoporosis are equally effective in changing beliefs and treatment motivation in an at-risk population. Visualisation devices are brief, cost-effective, have high acceptability and have considerable clinical applicability to promote awareness and prevention.
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Affiliation(s)
- Annie S K Jones
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
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Easthall C, Barnett N. Using Theory to Explore the Determinants of Medication Adherence; Moving Away from a One-Size-Fits-All Approach. PHARMACY 2017; 5:E50. [PMID: 28970462 PMCID: PMC5622362 DOI: 10.3390/pharmacy5030050] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 12/29/2022] Open
Abstract
Non-adherence to prescribed medicines has been described as "a worldwide problem of striking magnitude", diminishing treatment effects and wasting resources. Evidence syntheses report current adherence interventions achieve modest improvements at best, and highlight the poor progress toward the longstanding aim of a gold-standard intervention, tailored to meet individual need. Techniques such as motivational interviewing and health coaching, which aim to facilitate patient-centred care and improve patient resourcefulness, have shown promise in supporting adherence, especially in patients with psychological barriers to medicine-taking, such as illness perceptions and health beliefs. Despite a plethora of research, there is little recognition that the nature and complexity of non-adherence is such that a one-size-fits-all approach to interventions is never likely to suffice. This commentary re-visits the call for adherence interventions to be tailored to meet individual need, by considering what this means for day-to-day practice and how this can be achieved. It provides an update on advances in psychological theory to identify the root cause of an individual's non-adherence to encourage matching of provided adherence support. It also provides a practical perspective by considering exemplars of innovative practice and evaluating the day-to-day practicalities of taking a novel approach.
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Affiliation(s)
- Claire Easthall
- School of Healthcare, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - Nina Barnett
- London North West Healthcare NHS Trust & NHS Specialist Pharmacy Service, Pharmacy Department, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK.
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Campbell C, Braund R, Morris C. Beyond the four walls: an exploratory survey of location, employment and roles of pharmacists in primary health care. J Prim Health Care 2017. [DOI: 10.1071/hc17022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
ABSTRACT INTRODUCTION Recognition of the need to reduce harm and optimise patient outcomes from the use of medicines is contributing to an evolution of pharmacy practice in primary health care internationally. This evolution is changing community pharmacy and leading to new models of care that enable pharmacist contribution beyond traditional realms. There is little information about the extent of these changes in New Zealand. AIM The aim of this study was to investigate emerging roles of pharmacists in primary health care. METHODS A 10-question electronic survey was used to collect quantitative data about location, employment and roles of pharmacists practising in primary health care. RESULTS There were 467 survey responses. Although most pharmacists are employed by (78%, n = 357/458) and located in (84%, n = 393/467) community pharmacies, small numbers are dispersed widely across the primary health care sector. Of the 7% (n = 31/467) working in general practices, most are employed by Primary Health Organisations or District Health Boards. Limited cognitive pharmacy service provision is evident in the sector overall, but is much greater for pharmacists spending time located within general practices. DISCUSSION The large proportion of pharmacists practising in community pharmacies emphasises the importance of the Community Pharmacy Services Agreement in facilitating increased cognitive pharmacy service provision to optimise patient outcomes. The small numbers of pharmacists located elsewhere in the primary health care sector suggest there is scope to improve collaboration and integration in these areas. Flexible funding models that promote innovation and support sustainable practice change are key.
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Waring J, Latif A, Boyd M, Barber N, Elliott R. Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use. Soc Sci Med 2016; 148:123-30. [DOI: 10.1016/j.socscimed.2015.11.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/10/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
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