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Khayyat S, Walters P, Whittlesea C, Nazar H. Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study. BMJ Open 2021; 11:e043344. [PMID: 33664077 PMCID: PMC7934750 DOI: 10.1136/bmjopen-2020-043344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home. DESIGN AND SETTING A rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK. METHODS A mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts. PARTICIPANTS Any consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not. RESULTS Twenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients' lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved. CONCLUSION There was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services.
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Affiliation(s)
- Sarah Khayyat
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | | | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle, UK
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James R, Mantzourani E, Way C, Gray A, Burnley M, Hodson K. Using Technology-Supported Transfer of Care Systems: Informing Good Practice Recommendations. PHARMACY 2021; 9:pharmacy9010036. [PMID: 33670377 PMCID: PMC8005999 DOI: 10.3390/pharmacy9010036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
The Discharge Medicines Review (DMR) referral system, Refer-to-Pharmacy (RTP), PharmOutcomes and Help for Harry are UK transfer of care systems that aim to reduce the risks associated with hospital discharge. These systems use technology to facilitate the transmission of discharge information to community pharmacy, allowing community pharmacists to provide an adherence-support service. Despite the evidence that these systems benefit patient safety, there is a paucity of literature on their use. This study aimed to describe, compare and contrast these systems to highlight areas that could inform good practice recommendations. A rapid literature review was completed, and from the twenty-six sources of literature that were synthesised, three themes were identified for further exploration in semi-structured interviews with key informants: implementation, system attributes and stakeholder engagement. The key informants were purposively sampled for their role in the development and/or strategic implementation of each transfer of care system (n = 4). Audio recordings were transcribed ad verbatim and analysed both deductively and inductively. One interview was undertaken for each of the DMR, RTP and PharmOutcomes systems. Although all systems shared the same aim, differences were identified such as automated feedback for referrals, marketing strategies and practitioner accountability. Good practice recommendations suggested in this study could be applied to the future development of such systems.
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Affiliation(s)
- Robert James
- Cardiff School of Pharmacy & Pharmaceutical Sciences, King Edward VII Avenue, Cardiff CF10 3NB, UK; (R.J.); (E.M.)
| | - Efi Mantzourani
- Cardiff School of Pharmacy & Pharmaceutical Sciences, King Edward VII Avenue, Cardiff CF10 3NB, UK; (R.J.); (E.M.)
- NHS Wales Informatics Service, 21 Cowbridge Road East, Cardiff CF11 9AD, UK;
| | - Cheryl Way
- NHS Wales Informatics Service, 21 Cowbridge Road East, Cardiff CF11 9AD, UK;
| | - Alistair Gray
- East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK;
| | - Melissa Burnley
- Community Pharmacy West Yorkshire, Brooklands Court, Tunstall Road, Leeds LS11 5HL, UK;
| | - Karen Hodson
- Cardiff School of Pharmacy & Pharmaceutical Sciences, King Edward VII Avenue, Cardiff CF10 3NB, UK; (R.J.); (E.M.)
- Correspondence: ; Tel.: +44-02920-875806
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Luetsch K, Rowett D, Twigg MJ. A realist synthesis of pharmacist-conducted medication reviews in primary care after leaving hospital: what works for whom and why? BMJ Qual Saf 2020; 30:bmjqs-2020-011418. [PMID: 33127835 PMCID: PMC8070649 DOI: 10.1136/bmjqs-2020-011418] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Medication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes. OBJECTIVE A realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital. METHODS The realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms. RESULTS The synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients. CONCLUSIONS Medication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.
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Affiliation(s)
- Karen Luetsch
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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Wale A, Ireland M, Yemm R, Hiom S, Jones A, Spark JP, Francis M, May K, Allen L, Ridd S, Mantzourani E. Unlicensed "Special" Medicines: Understanding the Community Pharmacist Perspective. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:93-104. [PMID: 32884914 PMCID: PMC7431448 DOI: 10.2147/iprp.s263970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Community pharmacy staff are responsible for obtaining and supplying unlicensed “special” medicines to patients in primary care. Less well-defined parameters for safe and effective use of unlicensed compared to licensed medicines, along with issues around maintaining consistency between care settings or among manufacturers, have been associated with increased risks. This study aimed to explore the views and experiences of community pharmacy staff on accessing and supplying unlicensed “special” medicines to patients in Wales and the perceived impact of challenges faced on patient care. Methods A qualitative, phenomenological approach was employed, involving semi-structured interviews with pharmacists and pharmacy technicians working at one small chain of community pharmacies in Wales. The interview schedule focused on the personal experiences and perceptions of the participants on the processes involved in accessing and supplying unlicensed “special” medicines from a community pharmacy. Interviews were audio-recorded and transcribed verbatim. Results A total of six participants completed the interview. Three main themes were constructed from inductive thematic analysis of the transcribed interviews: requirement for additional patient responsibilities; influences on the confidence felt by pharmacy staff when accessing and supplying unlicensed “special” medicines; and continuity of supply. Conclusion This study gives a preliminary insight into the views and experiences of community pharmacy staff in Wales when accessing and supplying unlicensed “special” medicines. Further research is required to see if these views and experiences are representative of community pharmacy staff across the country.
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Affiliation(s)
- Alesha Wale
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Rowan Yemm
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Sarah Hiom
- St. Mary's Pharmaceutical Unit, Cardiff, Wales, UK
| | - Alison Jones
- St. Mary's Pharmaceutical Unit, Cardiff, Wales, UK
| | | | - Mark Francis
- Swansea Bay University Health Board, Swansea, Wales, UK
| | - Karen May
- Cardiff and Vale University Health Board, Swansea, Wales, UK
| | - Louise Allen
- Cardiff and Vale University Health Board, Swansea, Wales, UK
| | | | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.,NHS Wales Informatics Service, Cardiff, Wales, UK
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Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:71-81. [PMID: 32309200 PMCID: PMC7136570 DOI: 10.2147/iprp.s179628] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.
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Affiliation(s)
- Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Margie E Snyder
- College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
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Mantzourani E, Nazar H, Phibben C, Pang J, John G, Evans A, Thomas H, Way C, Hodson K. Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study. BMJ Open 2020; 10:e033551. [PMID: 32041857 PMCID: PMC7045023 DOI: 10.1136/bmjopen-2019-033551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the association of the discharge medicines review (DMR) community pharmacy service with hospital readmissions through linking National Health Service data sets. DESIGN Retrospective cohort study. SETTING All hospitals and 703 community pharmacies across Wales. PARTICIPANTS Inpatients meeting the referral criteria for a community pharmacy DMR. INTERVENTIONS Information related to the patient's medication and hospital stay is provided to the community pharmacists on discharge from hospital, who undertake a two-part service involving medicines reconciliation and a medicine use review. To investigate the association of this DMR service with hospital readmission, a data linking process was undertaken across six national databases. PRIMARY OUTCOME Rate of hospital readmission within 90 days for patients with and without a DMR part 1 started. SECONDARY OUTCOME Strength of association of age decile, sex, deprivation decile, diagnostic grouping and DMR type (started or not started) with reduction in readmission within 90 days. RESULTS 1923 patients were referred for a DMR over a 13-month period (February 2017-April 2018). Provision of DMR was found to be the most significant attributing factor to reducing likelihood of 90-day readmission using χ2 testing and classification methods. Cox regression survival analysis demonstrated that those receiving the intervention had a lower hospital readmission rate at 40 days (p<0.000, HR: 0.59739, CI 0.5043 to 0.7076). CONCLUSIONS DMR after a hospital discharge is associated with a reduction in risk of hospital readmission within 40 days. Linking data across disparate national data records is feasible but requires a complex processual architecture. There is a significant value for integrated informatics to improve continuity and coherency of care, and also to facilitate service optimisation, evaluation and evidenced-based practice.
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Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Hamde Nazar
- School of Pharmacy, The Faculty of Medical Services, Newcastle University, UK
| | | | | | - Gareth John
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | | | - Helen Thomas
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Cheryl Way
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
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