1
|
Lown M, Smith K, Muller I, Woods C, Maund E, Rogers K, Becque T, Hayward G, Moore M, Little P, Glogowska M, Hay A, Stuart B, Mantzourani E, Wilcox CR, Thompson N, Francis NA. Correction: Internet Tool to Support Self-Assessment and Self-Swabbing of Sore Throat: Development and Feasibility Study. J Med Internet Res 2024; 26:e59420. [PMID: 38669681 PMCID: PMC11087854 DOI: 10.2196/59420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
[This corrects the article DOI: 10.2196/39791.].
Collapse
Affiliation(s)
- Mark Lown
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Kirsten Smith
- School of Computing, University of PortsmouthPortsmouthUnited Kingdom
| | - Ingrid Muller
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Catherine Woods
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Emma Maund
- School of Healthcare Enterprise and Innovation, University of SouthamptonSouthamptonUnited Kingdom
| | - Kirsty Rogers
- Local Clinical Research Network WessexSouthamptonUnited Kingdom
| | - Taeko Becque
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Health Care Sciences, University of OxfordOxfordUnited Kingdom
| | - Michael Moore
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Paul Little
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Health Care Sciences, University of OxfordOxfordUnited Kingdom
| | - Alastair Hay
- Centre for Academic Primary Care, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Beth Stuart
- Pragmatic Clinical Trials Unit, Queen Mary University of LondonLondonUnited Kingdom
| | - Efi Mantzourani
- Cardiff School of Pharmacy, Cardiff UniversityCardiffUnited Kingdom
| | - Christopher R Wilcox
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Natalie Thompson
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| | - Nick A Francis
- Primary Care Research Centre, University of SouthamptonSouthamptonUnited Kingdom
| |
Collapse
|
2
|
Mantzourani E, James D, Akthar M, Brown S, Yemm R, Lehnbom E, Hanrahan J, Seage C. Can a mock medication-taking learning activity enable pharmacy students to experience the range of barriers and facilitators to medication adherence? An analysis informed by the Theoretical Domains Framework and COM-B model. Explor Res Clin Soc Pharm 2024; 13:100393. [PMID: 38192385 PMCID: PMC10772815 DOI: 10.1016/j.rcsop.2023.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Background Pharmacy professionals are well-placed to provide medication adherence support to patients. The Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) are two complementary models previously applied to medication-taking behaviour. Understanding the patient-specific barriers and facilitators to adherence using psychological frameworks from the early stages of pharmacy education enables the design and delivery of effective interventions. Objectives To examine whether a novel 'mock medicine' learning activity enabled students to experience the range of barriers and facilitators to medication adherence using the COM-B and TDF. Methods A mock medicine activity was conducted with students at pharmacy schools in three universities in the UK, Norway, and Australia over one week. Percentage adherence was calculated for five dosing regimens; theoretical framework analysis was applied to map reflective statements from student logs to COM-B and TDF. Results A total of 349 students (52.6%) returned completed logs, with high overall mean adherence (83.5%, range 0-100%). Analysis of the 277 (79.4%) students who provided reflective statements included barriers and facilitators that mapped onto one (9%), two (29%) or all three (62%) of the COM-B components and all fourteen TDF domains (overall mean = 4.04; Uni 1 = 3.72; Uni 2 = 4.50; Uni 3 = 4.38; range 1-8). Most frequently mapped domains were 'Environmental context and resources' (n = 199; 72%), 'Skills' (n = 186; 67%), 'Memory, attention and decision-making' (184; 66%) and 'Beliefs about capabilities' (n = 175; 63%). Conclusions This is the first study to utilise both COM-B and TDF to analyse a proxy measure of medication adherence in pharmacy education. Data mapping demonstrated that students experienced similar issues to patients when prescribed a short course of medication. Importantly, all the factors influencing medication-taking reported by students were captured by these two psychological frameworks. Future educational strategies will involve students in the mapping exercise to gain hands-on experience of using these psychological constructs in practice.
Collapse
Affiliation(s)
- E. Mantzourani
- Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - D.H. James
- Department of Applied Psychology, Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff, Wales, UK
- Department of Applied Psychology, School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - M.A. Akthar
- Department of Applied Psychology, School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - S.L. Brown
- Department of Applied Psychology, Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff, Wales, UK
| | - R. Yemm
- Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - E.C. Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - J.R. Hanrahan
- School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - C.H. Seage
- Department of Applied Psychology, School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| |
Collapse
|
3
|
Mantzourani E, Ahmed H, Evans A, Gunnarsson R, Cannings-John R. A pharmacy-led sore throat test and treat (STTT) service: antigen testing and antibiotic supply rates during the period of heightened public awareness of Group A Streptococcus infections. J Antimicrob Chemother 2024; 79:354-359. [PMID: 38134314 PMCID: PMC10832601 DOI: 10.1093/jac/dkad388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Community pharmacies in Wales delivered an NHS-funded sore throat test and treat (STTT) service during the period of increased invasive Group A Streptococcus (iGAS) incidents in winter 2022-23. Service users were screened using FeverPAIN/CENTOR scores, offered GAS rapid antigen detection tests (RADT) if appropriate, and antibiotics if indicated. OBJECTIVES To evaluate the service's response to a substantial rise in sore throat presentations during a period of heightened public anxiety. METHODS Cross-sectional study with anonymized individual-level data from electronic pharmacy records of all eligible STTT service users, between January 2022 and March 2023. RESULTS Antibiotics were supplied to 24% (95% CI: 23-24) of people who used the STTT service and 31% (95% CI: 31-32) of those who met the threshold for an RADT. Of 27 441 STTT consultations, 9308 (33.9%) occurred during December 2022. In the week commencing 2 December 2022, following the announcements of increased iGAS incidents, we observed a statistically significant increase of 1700 consultations (95% CI: 924-2476) and a statistically significant decrease in supply rate of 13.9 antibiotics per 100 RADT (95% CI: -18.40 to -9.40). Antibiotic supply rates increased thereafter to those observed before the announcements of iGAS incidents. Referral rates to other primary care or emergency settings remained below 10% throughout the study period. CONCLUSIONS Our findings suggest that, despite a dramatic increase in sore throat consultation rates in response to media reports, the pre-specified pathway followed by pharmacists ensured appropriate use of antibiotics, and absorbed a substantial workload that would otherwise end up in other healthcare settings.
Collapse
Affiliation(s)
- Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, Wales, UK
- Clinical Informatics, Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| | - Andrew Evans
- Primary Care Services, Welsh Government, Cardiff, Wales, UK
| | - Ronny Gunnarsson
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Development, Education and Innovation, Primary Health Care, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden
| | | |
Collapse
|
4
|
Lown M, Smith KA, Muller I, Woods C, Maund E, Rogers K, Becque T, Hayward G, Moore M, Little P, Glogowska M, Hay A, Stuart B, Mantzourani E, Wilcox CR, Thompson N, Francis NA. Internet Tool to Support Self-Assessment and Self-Swabbing of Sore Throat: Development and Feasibility Study. J Med Internet Res 2023; 25:e39791. [PMID: 38064265 PMCID: PMC10746968 DOI: 10.2196/39791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics. OBJECTIVE We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats. METHODS We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients' throat photographs. RESULTS A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples. CONCLUSIONS Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples.
Collapse
Affiliation(s)
- Mark Lown
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Kirsten A Smith
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Ingrid Muller
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Catherine Woods
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Emma Maund
- School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, United Kingdom
| | - Kirsty Rogers
- Local Clinical Research Network Wessex, Southampton, United Kingdom
| | - Taeko Becque
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Michael Moore
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Paul Little
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Alastair Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Beth Stuart
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Efi Mantzourani
- Cardiff School of Pharmacy, Cardiff University, Cardiff, United Kingdom
| | | | - Natalie Thompson
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Nick A Francis
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| |
Collapse
|
5
|
James R, Hodson K, Mantzourani E, Davies D. Exploring the implementation of Discharge Medicines Review referrals by hospital pharmacy professionals: A qualitative study using the consolidated framework for implementation research. Res Social Adm Pharm 2023; 19:1558-1569. [PMID: 37634995 DOI: 10.1016/j.sapharm.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The Discharge Medicines Review (DMR) is a community pharmacy service in Wales that aims to reduce medicines-related harm after care transitions, including hospital discharge. To undertake a DMR, the Community Pharmacist must receive a patient's discharge medicines information, either electronically, by fax or presented by the patient. Although the DMR has evidenced benefits for improving patient safety, its evaluation showed inconsistent uptake, which Community Pharmacists partially attributed to hospitals not providing the necessary information. OBJECTIVE Aiming to develop recommendations to improve hospital engagement to DMR referrals, this study explores hospital pharmacy professionals' views of the service. METHODS Qualitative focus groups, using hermeneutic phenomenology, were conducted in 16 hospitals across Wales, using a quota sampling method to include 61 Pharmacists and 31 Pharmacy Technicians. To understand the suboptimal engagement to DMR referrals, framework analysis was undertaken using the Consolidated Framework for Implementation Research (CFIR). RESULTS The data were mapped onto all five CFIR domains, each containing barriers and facilitators to engagement with DMR referrals and suggestions for improvement. Only one hospital had successfully implemented DMR referrals, with many participants lacking any knowledge of the service or how to refer to it. Specific barriers included a clear absence of processes to implement referrals and engage hospital pharmacy professionals. A considerable barrier was many participants' perceptions that Community Pharmacist roles were less clinically orientated and patient-centred than their own, viewing them almost as a different profession. Participants believed that local champions for DMR referrals could promote engagement and integrate them into the workflow of hospital pharmacy professionals. Further recommendations to improve engagement was staff training for DMRs and regular feedback of its value. CONCLUSION Policymakers may use the findings and recommendations from this study to promote hospital pharmacy staff engagement to similar community pharmacy services like the Discharge Medicines Service in England.
Collapse
Affiliation(s)
- Robert James
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK
| | - Duncan Davies
- Pharmacy Department, Swansea Bay University Health Board, Swansea, Wales, UK
| |
Collapse
|
6
|
Evans A, Mantzourani E, Gillespie D, Hughes L, Sharpe G, Yip N. Location, location, location: does providing public health services from community pharmacies contribute to tackling health inequalities? J Public Health (Oxf) 2023; 45:e478-e485. [PMID: 36502416 DOI: 10.1093/pubmed/fdac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/26/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Community pharmacies have long been advocated as an accessible source of advice on health improvement in communities. This cross-sectional study explored the association between provision of pharmacy public health services and factors that might influence the extent to which pharmacies contribute to tackling inequalities. METHODS Publically available data were used to explore the association between pharmacy public health service provision and pharmacy characteristics (socioeconomic deprivation, urbanity, opening hours and workload). Regression models were fitted to the number of service consultations. The association between the number of services provided and the mean number of consultations across each service was investigated using regression models. RESULTS Pharmacies showed a propensity for being situated in areas of higher socioeconomic deprivation. There was no association between socioeconomic deprivation and number of service consultations a pharmacy provided. Clustering of pharmacies in less affluent areas led to over half of all public health service consultations being in the two most deprived quintiles. CONCLUSIONS Providing healthcare services from pharmacies in more deprived areas does not mean the public use them or that pharmacies will prioritize their delivery. The higher prevalence of pharmacies in disadvantaged communities is an important factor in ensuring pharmacy services support reducing inequalities.
Collapse
Affiliation(s)
| | - Efi Mantzourani
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff CF10 3AT, UK
| | - Louise Hughes
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| | - Georgia Sharpe
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| | - Nicola Yip
- Health and Social Services Group, Welsh Government, Cardiff CF10 3NQ, UK
| |
Collapse
|
7
|
Wale A, Young Z, Zhang W, Hiom S, Ahmed H, Yemm R, Mantzourani E. Factors affecting the patient journey and patient care when receiving an unlicensed medicine: A systematic review. Res Social Adm Pharm 2023; 19:1025-1041. [PMID: 37121796 DOI: 10.1016/j.sapharm.2023.04.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents have reported facing challenges with unlicensed medicines at the points of transfer of care between settings, a key time when medication errors may occur. There is little known about the patient journey as a whole, or the factors affecting patient care when receiving an unlicensed medicine. OBJECTIVE A systematic review of UK literature to better understand factors that affect the entire patient journey from the decision to initiate treatment with an unlicensed medicine to the point at which treatment is supplied through a community pharmacy or ends. METHODS Scopus, OVID EMCARE, EMBASE, OVID Medline ALL, CINAHL, Web of Science and Joanna Briggs Institute were searched from 1968 (introduction of the Medicines Act) until November 2020, using the PRISMA guidelines. Narrative synthesis of UK studies was employed to analyse descriptive and qualitative data on any reported findings that would impact the patient journey or care related to the use of unlicensed medicines, and any described barriers or enablers. RESULTS Forty-five studies met criteria for final inclusion, with high levels of heterogeneity in terms of designs and methods. Specific challenges that were seen to impact the continuity of care across care settings, patient safety and provision of patient-centred care included diversity of clinical needs and impact of patient population age; healthcare professional awareness and acceptability of the use of unlicensed medicines; the hierarchical structure of the NHS; inconsistent doses and formulations with varying bioequivalence; patient/parent/carer/public awareness of unlicensed medicines use and perceived acceptability. CONCLUSIONS This review identified a clear need for consistent information to be provided to healthcare professional and patients alike to support the safe and effective use of unlicensed medicines across care settings.
Collapse
Affiliation(s)
- Alesha Wale
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Zoe Young
- University Library Services, Cardiff University, Cardiff, Wales, UK
| | - Wenjuan Zhang
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Sarah Hiom
- Research and Development, St Mary's Pharmaceutical Unit, Cardiff, Wales, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| | - Rowan Yemm
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
| |
Collapse
|
8
|
Mantzourani E, Deslandes R, Hodson K, Evans A, Taylor L, Lucas C. Community Pharmacists' Views on the Early Stages of Implementation of a National Pilot Independent Prescribing Service in Wales: A Qualitative Study. Integr Pharm Res Pract 2023; 12:11-23. [PMID: 36733975 PMCID: PMC9888007 DOI: 10.2147/iprp.s395322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023]
Abstract
Background A pilot Independent Prescribers' Service (IPS) was introduced in 13 community pharmacies across Wales in June 2020. Independent Pharmacist Prescribers (IPPs) could prescribe in the areas of management of acute conditions, contraception, or opioid withdrawal, as agreed with local commissioners. Access to the patients' medical records was provided via Choose Pharmacy, the national community pharmacy IT platform. Objective To explore the experiences of IPPs delivering the service and commissioners responsible for financial resources regarding the IPS in Wales. Methods A qualitative methodology was employed, with purposive sampling, semi-structured interviews, and inductive thematic analysis. Results Five themes were constructed from 13 interviews (n=9 IPPs; n=4 commissioners): (i) patient experience and safety; (ii) professional enablement and rebalancing workload of GPs; (iii) role and limitations of remote consultations; (iv) funding and business model; (v) functionality on Choose Pharmacy to support patient care. The design of the service allowed pharmacists to determine how best to deliver the IPS, maximizing access for patients and promoting a sense of professional value amongst pharmacists. Conclusion This study builds on the body of evidence on enhanced patient experience with prescribing services in the community, reinforcing that IPPs have a key role in rebalancing management of common conditions from GP surgeries to community pharmacies. Several considerations need to be addressed to ensure future success of the service implementation, delivery and enhanced sustainability, such as formal referral pathways and access to medical records. These can be used by other commissioning bodies in the UK and internationally to build a network of suitably supported IPPs, confident to appropriately deal with uncomplicated acute and chronic conditions; and liaise with primary and/or secondary care when referrals are needed.
Collapse
Affiliation(s)
- Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK,Primary Care, Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK,Correspondence: Efi Mantzourani, Redwood Building, Cardiff School of Pharmacy and Pharmaceutical Sciences, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK, Tel +44 2920 870452, Email
| | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Karen Hodson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Andrew Evans
- Primary Care Services, Welsh Government, Cardiff, Wales, UK
| | - Lydia Taylor
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Cherie Lucas
- Graduate School of Health (Pharmacy Discipline), University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Mantzourani E, Wasag D, Cannings-John R, Ahmed H, Evans A. Characteristics of the sore throat test and treat service in community pharmacies (STREP) in Wales: cross-sectional analysis of 11 304 consultations using anonymized electronic pharmacy records. J Antimicrob Chemother 2022; 78:84-92. [PMID: 36272134 PMCID: PMC9780525 DOI: 10.1093/jac/dkac358] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND An NHS-funded sore throat test and treat (STTT) service was introduced in selected community pharmacies in Wales. Service users were screened using FeverPAIN/Centor scores, offered rapid antigen detection testing (RADT) to detect group A Streptococcus if appropriate, and supplied with antibiotics (by the pharmacist) if indicated. Following an initial evaluation, the service was rolled out nationally. OBJECTIVES This study forms part of the long-term STTT evaluation. The aim was to describe characteristics of the service and service users, the delivery, service outcomes, patient safety and antibiotic prescribing. METHODS Cross-sectional descriptive study using anonymized individual-level data from electronic pharmacy records of all eligible STTT service users between November 2018 and February 2020. RESULTS We identified 11 304 pharmacy STTT consultations in service users aged 6 years and over, with a median age of 25 years (IQR: 12 to 44). RADT was undertaken in 8666 (76.7%) consultations with 2503 (28.9% of RADT) positive tests. In total, 2406 (21.3%) service users were supplied with antibiotics. Pharmacists managed 91% of consultations in the pharmacy and referred only 937 (9.3%) service users to a GP and 27 (0.2%) to the Emergency Department. Higher rates of antibiotic supply were observed in out-of-hours consultations when compared with in-hours (24.9% versus 20.9%). CONCLUSIONS This is the largest description of a pharmacy-led STTT service to date and suggests it can be delivered at scale to align with a pre-specified pathway that promotes appropriate use of RADT and antibiotics. The service could substantially reduce workload from a common illness in other heavily pressurized areas of primary and emergency care.
Collapse
Affiliation(s)
| | - Diana Wasag
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| | | | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| | - Andrew Evans
- Primary Care Services, Welsh Government, Cardiff, Wales, UK
| |
Collapse
|
10
|
Lown M, Miles EA, Fisk HL, Smith KA, Muller I, Maund E, Rogers K, Becque T, Hayward G, Moore M, Little P, Glogowska M, Hay AD, Stuart B, Mantzourani E, Butler C, Bostock J, Davies F, Dickerson I, Thompson N, Francis N. Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: Feasibility study. Front Immunol 2022; 13:1016181. [PMID: 36275691 PMCID: PMC9582425 DOI: 10.3389/fimmu.2022.1016181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Sore throat is a common reason for overuse of antibiotics. The value of inflammatory or biomarkers in throat swab or saliva samples in predicting benefit from antibiotics is unknown. Methods We used the ‘person-based approach’ to develop an online tool to support self-swabbing and recruited adults and children with sore throats through participating general practices and social media. Participants took bacterial and viral swabs and a saliva sponge swab and passive drool sample. Bacterial swabs were cultured for streptococcus (Group A, B, C, F and G). The viral swab and saliva samples were tested using a routine respiratory panel PCR and Covid-19 PCR testing. We used remaining viral swab and saliva sample volume for biomarker analysis using a panel of 13 biomarkers. Results We recruited 11 asymptomatic participants and 45 symptomatic participants. From 45 symptomatic participants, bacterial throat swab, viral throat swab, saliva sponge and saliva drool samples were returned by 41/45 (91.1%), 43/45 (95.6%), 43/45 (95.6%) and 43/45 (95.6%) participants respectively. Three saliva sponge and 6 saliva drool samples were of insufficient quantity. Two adult participants had positive bacterial swabs. Six participants had a virus detected from at least one sample (swab or saliva). All of the biomarkers assessed were detectable from all samples where there was sufficient volume for testing. For most biomarkers we found higher concentrations in the saliva samples. Due to low numbers, we were not able to compare biomarker concentrations in those who did and did not have a bacterial pathogen detected. We found no evidence of a difference between biomarker concentrations between the symptomatic and asymptomatic participants but the distributions were wide. Conclusions We have demonstrated that it is feasible for patients with sore throat to self-swab and provide saliva samples for pathogen and biomarker analysis. Typical bacterial and viral pathogens were detected but at low prevalence rates. Further work is needed to determine if measuring biomarkers using oropharyngeal samples can help to differentiate between viral and bacterial pathogens in patients classified as medium or high risk using clinical scores, in order to better guide antibiotic prescribing and reduce inappropriate prescriptions.
Collapse
Affiliation(s)
- Mark Lown
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
- *Correspondence: Mark Lown,
| | - Elizabeth A. Miles
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Helena L. Fisk
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kirsten A. Smith
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Ingrid Muller
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Emma Maund
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Kirsty Rogers
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Taeko Becque
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - Michael Moore
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - Alastair D. Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Chris Butler
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - Jennifer Bostock
- Southampton Primary Care Research Centre, Patient and Public Involvement Representative, Southampton, United Kingdom
| | - Firoza Davies
- Southampton Primary Care Research Centre, Patient and Public Involvement Representative, Southampton, United Kingdom
| | - Ian Dickerson
- Southampton Primary Care Research Centre, Patient and Public Involvement Representative, Southampton, United Kingdom
| | - Natalie Thompson
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Nick Francis
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
11
|
Turner S, Ahmed H, Akbari A, Bethel J, Cannings-John R, Evans A, Mantzourani E. Evaluation of a Sore throat Test and tReat servicE in community Pharmacies (STREP). Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesA Sore Throat Test and Treat (STTT) service was introduced in selected community pharmacies to screen against Streptococcus A and appropriately treat infections, relieving pressure on General Practices (GP). The long-term impact on patient and NHS outcomes is unclear. A robust evaluation is required to inform future policy and roll-out.
ApproachA matched cohort study comparing patients who received an STTT consultation in community pharmacy (exposed) compared to consultation with GP (unexposed). Individual-level data from participating STTT pharmacies were extracted from the Choose Pharmacy IT platform, anonymised and acquired into the Secure Anonymised Information Linkage (SAIL) Databank. Both cohorts were linked to other longitudinal health and administrative data within SAIL to create study outcomes (e.g. antibiotic prescribing, re-consultation, attendance/admission at Emergency Department/hospital). The impact of the STTT service was evaluated by modelling the outcomes using logistic regression to calculate odds ratios.
Results7553 patients exposed to the STTT service (8,313 consultations) in community pharmacies in Cwm Taf Morgannwg and Betsi Cadwaladr University Health Boards between 1st November 2018 and 28th February 2020, were successfully anonymised and acquired into the SAIL Databank (97.16%). 99.5% of these individuals were then linked to the Welsh Demographic Service Dataset (WDSD), enabling demographics to be generated. 6,665 distinct consultations remained in the exposed group after exclusion criteria were applied. A matched unexposed cohort will be created, and odds ratios will be presented to compare the risk of each outcome for those exposed to the STTT service compared to usual care.
ConclusionThis innovative study is the first to link national pharmacy service data to individual-level population-scale longitudinal health and administrative data in the SAIL Databank. Our findings will inform clear and actionable recommendations regarding the service design and future roll-out of STTT services across the UK and internationally.
Collapse
|
12
|
Deslandes R, Mantzourani E, Hodson K, Taylor L. Views of independent prescribing pharmacists on the community pharmacy pilot independent prescribing service: a qualitative study. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac019.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Independent Prescribing Pharmacists (IPPs) can prescribe autonomously within their scope of practice. Their role is increasing within the community setting (1). The Welsh Pharmaceutical Committee has a vision to have at least one IPP in every community pharmacy by 2030 (1). In 2020, an Independent Prescribers’ Service (IPS) pilot was delivered in 13 pharmacies across six of the seven Health Boards in Wales (2), via Choose Pharmacy (CP), an IT platform that provides access to patients’ General Practitioner (GP) medical record. IPS allowed patients to access advice, and, where relevant, be treated in the community pharmacy setting, rather than the GP surgery. The consultation is recorded on CP and the patient’s GP informed of the outcome. As the IPS is a recent development there is little research on this service.
Aim
To explore the views of community IPPs delivering the IPS.
Methods
A qualitative methodology was utilised with semi-structured interviews, via telephone or MS Teams. Only thirteen pharmacies were commissioned to deliver the service. Purposive sampling was used to identify IPPs in these premises, who had completed at least one IPS consultation. Participants were informed of the study and written; informed consent obtained. An interview schedule utilised open questions to explore participants’ experiences of the service. Interviews were recorded, transcribed and analysed via deductive and inductive thematic analysis. Analysis was quality assured through discussion with the research team. All identifiable information in the transcripts were removed to ensure anonymity.
Results
Nine interviews were conducted, including participants from all Health Boards in the pilot. Interviewees had varied prescribing experience with some only prescribing since the roll out of the pilot. The IPPs’ scope of practice included acute minor ailments, contraception, urinary tract infections and asthma. Four themes were identified: 1.Impact of the IPS: Participants believed the service had impacted on the wider healthcare setting, patients and themselves. Patients had improved convenience and accessibility to a healthcare professional to manage their condition. Patient safety was of a high standard with access to patient notes ensuring informed, appropriate clinical decisions. 2.Relationship with GP: Positive relationships with local GPs was believed to be critical to the pilot’s success. 3.Future delivery: This will rely on support, funding, and ongoing review. A ‘blended approach’ whereby patients are seen with or without an appointment was believed to provide the flexibility that patients want. 4.Remote consultations: Can have an impact on patient safety, making non-verbal communication and language barriers more challenging. After nine interviews, no new information was gathered.
Conclusion
Participants were supportive of the service which will potentially benefit IPPs, patients and GPs, and improve patient care. Pharmacists, by providing a high quality, accessible service, ensures that forward thinking healthcare is delivered in a manner which makes use of the skills of those working in the community. The study, albeit small scale, explored the thoughts of the majority of IPPs conducting the IPS service at that time. More information is needed to understand the impact of the service and effect on practice, from the practitioner and patient perspective.
References
(1) Walsh A. All Welsh pharmacies to have independent prescribers. Wales; 2019 [accessed 5 February 2021]. Available from: http://www.pharmacymagazine.co.uk/all-welsh-pharmacies-to-have-independent-prescribers
(2) NHS Wales Informatics Service. Choose Pharmacy. Wales; 2021 [accessed 5 Feb 2021]. Available from: http://www.nwis.nhs.wales/systems-and-services/in-the-community/choose-pharmacy/
Collapse
Affiliation(s)
- R Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - E Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
- Primary Care, Digital Health and Care Wales, NHS Wales, Cardiff, UK
| | - K Hodson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - L Taylor
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
13
|
Mantzourani E, Cannings-John R, Evans A, Ahmed H. To swab or not to swab? Using point-of-care tests to detect Group A Streptococcus infections as part of a Sore Throat Test and Treat service in community pharmacy. J Antimicrob Chemother 2022; 77:803-806. [PMID: 35038341 PMCID: PMC8865000 DOI: 10.1093/jac/dkab470] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background The community pharmacy-led Sore Throat Test and Treat (STTT) service in Wales allowed pharmacists to undertake a structured clinical assessment with FeverPAIN/Centor scores and a point-of-care test (POCT) for Group A Streptococcus (GAS) infection. A new service model was temporarily agreed as a result of COVID-19, without routine use of POCT. Objectives To explore the impact of removing the requirement for GAS POCT from a community pharmacy STTT service on antibiotic supply. Methods Analysis of STTT consultation data, obtained for two periods: November 2018 (date the service went live) to September 2019 (pre-pandemic); and November 2020 (date the new service model was introduced) to May 2021. Results For consultations eligible for POCT, the antibiotic supply rate increased from 27% (922/3369) (95% CI: 26%–29%) with the pre-pandemic service model (FeverPAIN/Centor + POCT) to 63% (93/147) (95% CI: 55%–71%) with the new model (FeverPAIN/Centor only); the percentage of patients who were not issued an antibiotic, despite their high clinical score, decreased from 56% (646/1154) to 9.3% (8/86). Conclusions Preliminary data suggest that for every 100 STTT consultations with patients with a Centor score of ≥3 or a FeverPAIN score of ≥2, the use of POCT may spare up to 36 courses of antibiotics, increasing to 47 for patients with higher clinical scores, suggesting that the pre-COVID delivery model (FeverPAIN/Centor + POCT) is the optimal pathway and POCT in addition to clinical scores may result in fewer antibiotic prescriptions for sore throat symptoms. These findings have implications for STTT service delivery during and beyond the COVID-19 pandemic.
Collapse
Affiliation(s)
- Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.,Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK
| | | | - Andrew Evans
- Primary Care Services, Welsh Government, Cardiff, Wales, UK
| | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, Wales, UK
| |
Collapse
|
14
|
Langran C, Mantzourani E, Hughes L, Hall K, Willis S. “I'm at breaking point”; Exploring pharmacists' resilience, coping and burnout during the COVID-19 pandemic. Exploratory Research in Clinical and Social Pharmacy 2022; 5:100104. [PMID: 35072149 PMCID: PMC8760739 DOI: 10.1016/j.rcsop.2022.100104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background There is a lack of evidence on how the multimodal dynamic process of resilience has impacted personal adaptation of frontline healthcare professionals, working under extreme pressure during the COVID-19 global pandemic. Objectives To explore resilience, burnout and wellbeing for UK pharmacists in patient-facing roles, including individual and organisational factors that align to the ABC-X theoretical model of the dynamic process of resilience. Methods A non-experimental pragmatist research design was adopted, with a cross-sectional online survey distributed via social media and professional networks between June and July 2020. Quantitative data aligned to a positivist research paradigm was collected using validated scores, to statistically analyse wellbeing, burnout and resilience. Qualitative textual data, consistent with an interpretivist research paradigm, were analysed following an inductive thematic approach. Results A total of 199 surveys from pharmacists working within community, hospital and GP sectors were analysed. Wellbeing scores were strongly correlated to resilience scores. Wellbeing and resilience scores were both inversely correlated with burnout scores. Two-thirds of participants were classified as high-risk within the burnout scales. Key stressors were highlighted by participants, who described how individual resources and perceptions shaped their experience, which overall contributed to their burnout. Organisations that supported pharmacists embraced change and quickly adopted new ways of working, such as teleconsultations, flexible and remote working, redesign of workflow, alongside clear guidance. However, there was also reported frustration at lack of, slow or conflicting guidance from employers. Conclusions This study adds to the growing evidence base for how individuals are affected by adverse events in a dynamic environment, alongside the role that employers can play in supporting individual and organisational resilience. It provides an opportunity to learn from pharmacists' responses to the COVID-19 pandemic, and a call to action for healthcare organisations to rebuild and invest resources into sustained support for staff wellbeing.
Collapse
Affiliation(s)
- C. Langran
- University of Reading, UK
- Corresponding author.
| | | | | | | | | |
Collapse
|
15
|
Taylor SM, Cairns A, Mantzourani E, Glass BD. LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme): a feasibility study protocol for a community pharmacy-based ear health intervention. Pilot Feasibility Stud 2021; 7:124. [PMID: 34127060 PMCID: PMC8200546 DOI: 10.1186/s40814-021-00856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ear disease is a major cause of preventable hearing loss and is very common in rural communities, estimated to affect 1.3 million Australians. Rural community pharmacists are well placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP). The purpose of this study is to apply an ear health intervention to the rural community-pharmacy setting in Queensland, Australia, to improve the management of ear disease. The aims are the following: (1) to evaluate the feasibility, potential effectiveness and acceptability of a community pharmacy-based intervention for ear health, (2) to evaluate the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy and (3) to evaluate the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities. METHODS/DESIGN This is a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. Usual care practices pertaining to the management of ear complaints will be recorded prior to the intervention for 8 weeks. The intervention will then be piloted for 6 weeks, followed by a 12 month impact study. Patients aged > 13 years presenting to the pharmacies with an ear complaint will be invited to participate. Trained pharmacists will conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a general practitioner (GP) if required, according to the study protocol. Patients will complete a satisfaction survey and receive a follow-up phone call at 7 days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data. DISCUSSION This study will demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry Number: ACTRN12620001297910 .
Collapse
Affiliation(s)
- Selina Maree Taylor
- Centre for Rural and Remote Health - Mount Isa, 100 Joan Street, Mount Isa, QLD Australia
| | - Alice Cairns
- Centre for Rural and Remote Health - Weipa, 407 John Evans Drive, Trunding, QLD Australia
| | - Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK
- Primary Care, NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Beverley D. Glass
- College of Medicine and Dentistry, James Cook University, Townsville, QLD Australia
| |
Collapse
|
16
|
Chang H, Desselle S, Canedo J, Mantzourani E. Reflections of mentors and mentees on a national mentoring programme for pharmacists in the United Kingdom: An examination into organisational culture and systems. Res Social Adm Pharm 2021; 18:2659-2669. [PMID: 34210642 DOI: 10.1016/j.sapharm.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is no accepted or consistent model for delivering mentoring programmes, manifesting in some debate surrounding the ideal conducive system. Mentorship structures and culture within pharmacy can be advanced by researching experiences of mentors and mentees. OBJECTIVE To explore lived experiences of participants in a nationwide mentoring programme in relation to motivations and barriers associated with engaging with mentoring, and what system changes and organisational culture shift could further support mentoring for pharmacy professionals. METHODS This study adopted a constructivist research paradigm, with a qualitative design to focus on how participants interpreted the world and their experiences. Verbatim transcripts of recordings were examined using deductive and inductive thematic analysis. RESULTS Participants in twenty one-to-one interviews appreciated the programme's allowance for organic relationships to occur, its contribution towards advancing the profession forward, its flexibility, and available resources. They discussed training needs and a more formal onboarding process into the programme that facilitated greater awareness of resources, as well as the need to evaluate and tweak it. System changes were highlighted so that mentoring can be part of the organisational culture, such as incorporating mentoring in job descriptions to increase capacity, senior members of the profession acting as role models, and linking mentoring to existing education and development structures. CONCLUSION Data demonstrated the need for formal structure but that which allowed for informal and organic relationships to develop. It is paramount for sponsoring organisations to provide resources and continuously monitor the program. The rich information gathered on administrative support and structure of a mentoring programme, along with its organisational facets, should help organisations when implementing similar initiatives. An organisation sponsoring or administering a mentoring programme must take actions that help codify its mentoring culture and its advocacy of mentoring as key to advancement for its profession's members.
Collapse
Affiliation(s)
- Helen Chang
- The Royal Pharmaceutical Society of Great Britain, London, UK.
| | | | | | - Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK.
| |
Collapse
|
17
|
Mantzourani E, Chang H, Desselle S, Canedo J, Fleming G. Reflections of mentors and mentees on a national mentoring programme for pharmacists: An examination into relationships, personal and professional development. Res Social Adm Pharm 2021; 18:2495-2504. [DOI: 10.1016/j.sapharm.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
|
18
|
Langran C, Willis S, Hughes L, Mantzourani E, Hall K. Intra and Inter-professional working: how have pharmacists’ working practices changed during the COVID-19 pandemic? International Journal of Pharmacy Practice 2021. [PMCID: PMC8083675 DOI: 10.1093/ijpp/riab015.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction COVID-19 has acted as a catalyst for radical changes in the working practices of pharmacists. While there is emerging evidence of adaptability mitigating burnout amongst pharmacists in other countries (1), what has yet to be established is the extent to which the well-being and resilience of pharmacists in the UK may be supported through changes in intra and inter-professional working practices. Aim As part of a wider project aiming to explore the impact of COVID-19 on pharmacists’ wellbeing and resilience, in this abstract we present findings exploring the impact on working relationships within pharmacy and multidisciplinary teams. Methods An online questionnaire containing validated measures of wellbeing and resilience and free-text open questions exploring the impact of COVID-19 on working practices was piloted on five practising pharmacists. This questionnaire was subsequently distributed via social media and professional networks in June 2020. Convenience sampling was used whereby any UK-registered pharmacist in a patient-facing role was eligible to take part. Inductive thematic analysis of the free text responses was conducted. This abstract presents one key theme; intra and inter-professional relationships. Results A total of 202 questionnaires were completed (Table 1), with 192 participants entering free-text responses. Participants reported pharmacy teams becoming closer, supporting one another and working more cohesively. Work redesign and staff upskilling were given as positive examples of practice change in response to the pandemic. Reported challenges included managing conflict within a team due to heightened stress, sustaining staff morale, exhaustion, and prioritising others to the detriment of their own wellbeing: “I have no time for myself as I'm too busy keeping the day to day working and supporting my team emotionally. I'm emotionally exhausted and at home I withdraw and ignore the outside world as I'm at breaking point but don’t want my colleagues to see this.” Inter-professional relationships sometimes improved as a result of more effective communication, extended networking and pharmacists feeling valued and recognised as integral to multidisciplinary working. Supportive inter-professional working was described as a “Great sense of comradery - we're in this together”. Yet for others, inter-professional working proved challenging, with non-engagement of clinicians, frequently changing guidance from senior management, and restricted staff interaction due to remote or shift working. Conclusions Whilst for some the pandemic facilitated improved inter- and intra- professional interactions, for others this was viewed as challenges of daily practice. Due to recruiting via social media, this study is limited by the response numbers and is therefore not representative of all UK registered pharmacists. However, a key strength is that pharmacists from all sectors of practice responded, in comparison to other studies which have focused solely on community pharmacists. Results from this study can be used to support sustainable change in fostering collaborative working within pharmacy and multi-professional healthcare teams. References 1. Austin, Z., & Gregory, P. (2020). Resilience in the time of pandemic: The experience of community pharmacists in Ontario during COVID-19. Research in Social and Administrative Pharmacy.
Collapse
Affiliation(s)
| | | | | | | | - K Hall
- University of Reading, UK
| |
Collapse
|
19
|
James R, Mantzourani E, Way C, Gray A, Burnley M, Hodson K. Using Technology-Supported Transfer of Care Systems: Informing Good Practice Recommendations. Pharmacy (Basel) 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
20
|
Desselle SP, Chang H, Fleming G, Habib A, Canedo J, Mantzourani E. Design fundamentals of mentoring programs for pharmacy professionals (Part 1): Considerations for organizations. Res Social Adm Pharm 2021; 17:441-448. [DOI: 10.1016/j.sapharm.2020.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
|
21
|
Mantzourani E, Chang H, Fleming G, Desselle SP. Design fundamentals of mentoring programs for pharmacy professionals (Part 2): Considerations for mentors and mentees. Res Social Adm Pharm 2021; 17:449-455. [DOI: 10.1016/j.sapharm.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
|
22
|
Mantzourani E, Evans A, Cannings-John R, Ahmed H, Hood K, Reid N, Howe R, Williams E, Way C. Impact of a pilot NHS-funded sore throat test and treat service in community pharmacies on provision and quality of patient care. BMJ Open Qual 2020; 9:bmjoq-2019-000833. [PMID: 32111608 PMCID: PMC7047494 DOI: 10.1136/bmjoq-2019-000833] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/08/2020] [Accepted: 02/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective A National Health Service (NHS)-funded sore throat test and treat (STTT) service was introduced in selected pharmacies in two local health boards in Wales, as an extension to the national pharmacy common ailment scheme. The aim of this study was to evaluate the impact of STTT on provision and quality of patient care, namely antibiotic use, patient safety and general practitioner (GP) consultation rates. Methods Secondary analyses of STTT consultation data to describe service outcomes, and routine data to explore changes in antibiotic prescribing and the prevalence of complications. Data were also collected from one GP practice to explore the feasibility of measuring changes in sore throat consultation rates in general practice. Results Less than 20% of 1725 consultations resulted in antibiotic supply. The availability of STTT was associated with greater reductions in prescriptions for phenoxymethylpenicillin than in areas where STTT was not available (−3.8% and −3.4%, difference 0.4%). When pharmacy supplies were included, the reductions in the supply of the antibiotic were similar. No increase in the monthly number of incidents of quinsy was detected, and patients were appropriately referred to other healthcare professionals during pharmacy consultations. GP consultation rates since introduction of STTT were found to be lower than the equivalent monthly average since 2014. Conclusions Data from the first 5 months of the STTT service suggest that it may have a role in safely rebalancing uncomplicated sore throat management from general practice to community pharmacies while continuing to promote antibiotic stewardship.
Collapse
Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK .,Primary Care, Information and Communications Technology, NHS Wales Informatics Service, Cardiff, UK
| | - Andrew Evans
- Health and Social Services Group, Welsh Government, Cardiff, UK
| | | | - Haroon Ahmed
- Division of Population Medicine, Cardiff University, Cardiff, South Glamorgan, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, South Glamorgan, UK
| | - Nicholas Reid
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.,Health Protection Division, Public Health Wales, Cardiff, UK
| | - Robin Howe
- Microbiology, Public Health Wales, Cardiff, UK
| | - Emma Williams
- Primary Care, Information and Communications Technology, NHS Wales Informatics Service, Cardiff, UK
| | - Cheryl Way
- Clinical Informatics, NHS Wales Informatics Service, Cardiff, UK
| |
Collapse
|
23
|
Gray A, Mackie C, Price W, Coupe E, Holgate S, Watson E, Eatough J, Fletcher N, Hodson K, Mantzourani E. Learning from Practice: How East Lancashire Hospitals' Pharmacy Service Has Embraced Information Technology. Pharmacy (Basel) 2020; 8:pharmacy8040177. [PMID: 32992957 PMCID: PMC7712938 DOI: 10.3390/pharmacy8040177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as 'let's make things better'. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy. However, like all Trusts, we have many electronic systems which offer interoperability, or can support making it easier for the pharmacy team to do a good job. This article describes the many fronts we have worked on over the last ten plus years. Taken individually, the elements cannot be considered as revolutionary; together, they have helped us develop and deliver the safe, personal and effective pharmacy service that we call dedicated ward pharmacy.
Collapse
Affiliation(s)
- Alistair Gray
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
- Correspondence: ; Tel.: +44-1254-732-253
| | - Clare Mackie
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - William Price
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - Emma Coupe
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - Susan Holgate
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - Emma Watson
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - John Eatough
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - Neil Fletcher
- Pharmacy Department, Royal Blackburn Teaching Hospital, Blackburn, Lancashire BB2 3HH, UK; (C.M.); (W.P.); (E.C.); (S.H.); (E.W.); (J.E.); (N.F.)
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales CF10 3NB, UK; (K.H.); (E.M.)
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales CF10 3NB, UK; (K.H.); (E.M.)
- Primary Care, NHS Wales Informatics Service, Cardiff, Wales CF11 9AD, UK
| |
Collapse
|
24
|
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. Integr Pharm Res Pract 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
25
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
26
|
Mantzourani E, Hicks R, Evans A, Williams E, Way C, Deslandes R. Community Pharmacist Views On The Early Stages Of Implementation Of A Pathfinder Sore Throat Test And Treat Service In Wales: An Exploratory Study. Integr Pharm Res Pract 2019; 8:105-113. [PMID: 31815100 PMCID: PMC6858457 DOI: 10.2147/iprp.s225333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives To explore the views and opinions of community pharmacists regarding their initial experience of and levels of preparedness for the pathfinder sore throat test and treat (STTT) service in Wales. Methods A phenomenological qualitative approach with constructivist paradigm was adopted as the first cycle of ongoing action research. Semi-structured interviews with community pharmacists who had completed at least three consultations within the first 3 weeks of the service were conducted, with informed consent and audio recorded. Interviews were transcribed ad verbatim and data were thematically analysed both inductively and deductively. Results A total of seven interviews with pharmacists who had conducted more than three consultations identified three main themes: 1) perceived impact of the service on patient care, including the value of the structure and technology infrastructure, the role of STTT towards antimicrobial stewardship, and its potential role in rebalancing primary care resources so that workload is distributed appropriately among healthcare professionals; 2) factors that empower pharmacists to deliver the service, in particular quality and consistency of training, appropriate staffing resource and internally motivated willingness to engage; 3) interface with GP surgeries such as nature of existing relationships before implementing the service, role of GP staff and GP perceived value of STTT. Conclusion The pathfinder STTT service has been well received by pharmacists who recognised the service’s role in providing patient education and contributing to principles of antimicrobial stewardship and described factors that would empower them to deliver the service confidently. Results have been fed back to the service implementation team to inform future developments.
Collapse
Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.,NHS Wales Informatics Service, Primary Care Services, Cardiff, Wales, UK
| | - Ricky Hicks
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Andrew Evans
- Welsh Government, Health and Social Services, Cardiff, Wales, UK
| | - Emma Williams
- NHS Wales Informatics Service, Primary Care Services, Cardiff, Wales, UK
| | - Cheryl Way
- NHS Wales Informatics Service, Primary Care Services, Cardiff, Wales, UK
| | - Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| |
Collapse
|
27
|
Lucas C, Smith L, Lonie JM, Hough M, Rogers K, Mantzourani E. Can a reflective rubric be applied consistently with raters globally? A study across three countries. Curr Pharm Teach Learn 2019; 11:987-994. [PMID: 31685182 DOI: 10.1016/j.cptl.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 05/28/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Reflection is a powerful tool for assisting students to develop the skills to make better informed decisions. As a pharmacy competency standard, reliable and fair assessment strategies are required to measure reflective skills and support students in developing their reflective capacity. The aim of this research was to explore whether we can extend the applicability of a previously tested rubric to a range of educational settings, to account for diversity of pharmacy educators and curricula internationally. METHODS Four raters from three countries applied a reflective rubric to assess a sample (n = 43) of reflective accounts, representing 41% of a cohort of 105 second-year undergraduate pharmacy students. The interrater reliability (IRR) was measured utilizing the intra-class correlation coefficient (ICC), using a two-way random effects model with absolute agreement, to determine the level of agreement between the raters' absolute scores. Generalizability Theory analysis was used to estimate generalizability of raters and stages. RESULTS Results indicated agreement of raters for (i) each of the seven stages of reflection and (ii) overall score for the reflective account, with moderate to substantial agreement (ICC = 0.55-0.69, p < 0.001); and high agreement for all raters for the overall score (ICC = 0.96, p < 0.001), respectively. The G-Study estimated a relative error coefficient of 0.78. CONCLUSION This additional analysis further confirms the reliability and applicability of the rubric to a range of rater academic backgrounds.
Collapse
Affiliation(s)
- Cherie Lucas
- University of Technology Sydney, Graduate School of Health (Pharmacy), Sydney, Australia.
| | - Lorraine Smith
- The University of Sydney, Faculty of Medicine and Health, Australia.
| | - John M Lonie
- Long Island University, College of Pharmacy, New York, United States.
| | - Michael Hough
- University of Technology Sydney, Graduate School of Health (Clinical Psychology), PO Box 123, Broadway, NSW 2007, Australia.
| | - Kris Rogers
- University of Technology Sydney, Graduate School of Health (Biostatistician), PO Box 123, Broadway, NSW 2007, Australia.
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, Wales, UK.
| |
Collapse
|
28
|
Mantzourani E, Hodson K, Evans A, Alzetani S, Hayward R, Deslandes R, Hughes ML, Holyfield G, Way C. A 5-year evaluation of the emergency contraception enhanced community pharmacy service provided in Wales. BMJ Sex Reprod Health 2019; 45:bmjsrh-2018-200236. [PMID: 31395752 DOI: 10.1136/bmjsrh-2018-200236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Access to emergency contraception (EC) has been a core component of attempts to address high teenage pregnancy rates in Wales. A national service was commissioned in 2011, allowing supply of EC free of charge from community pharmacies (CPs). This study investigated 5 years of the EC service, to describe its use and investigate changes in the pattern of use over time. METHODS Secondary analyses of data from all National Health Service funded CP EC consultations in Wales between 1 August 2012 and 31 July 2017 (n=181 359). Data comprised standardised clinical and demographic information, in the form of predefined service user responses, submitted for reimbursement by CPs. RESULTS Overall service provision remained relatively consistent over the study period, with women aged between 13 and 59 years accessing the service. An association was observed between the time since unprotected sexual intercourse and the day on which the service was accessed (Χ2(18)=16 292.327, p<0.001). Almost half (47.9%) of requests were because no contraception had been used, with a strong and positive association for teenagers and women aged 40+ years. A statistically significant and increasing percentage of consultations were accompanied by further sexual health advice (r=0.7, p<0.01). CONCLUSIONS Access to EC through CPs is contributing to reducing teenage conceptions and termination rates. However, action is needed to increase contraception use in all age groups. Reduced availability of CP services on Sundays is a barrier to timely EC access. Findings support an expanded role for community pharmacists in provision of regular contraception.
Collapse
Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | - Sarah Alzetani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Hayward
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Mary Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | - Cheryl Way
- National Health Service Wales Informatics Service, Cardiff, UK
| |
Collapse
|
29
|
Deslandes R, Evans A, Baker S, Hodson K, Mantzourani E, Price K, Way C, Hughes L. Community pharmacists at the heart of public health: A longitudinal evaluation of the community pharmacy influenza vaccination service. Res Social Adm Pharm 2019; 16:497-502. [PMID: 31262643 DOI: 10.1016/j.sapharm.2019.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Influenza ("flu") is a contagious viral infection causing approximately 600 deaths/year in the United Kingdom. Annual vaccination is the most effective prevention strategy with a target of 75% uptake in 'at-risk' patient groups. Before 2012, immunisation was conducted in General Practice (GP), but uptake was below target. NHS Wales therefore introduced a programme allowing community pharmacists to administer the vaccine to certain patient groups. OBJECTIVES: This study aimed to evaluate the community pharmacy (CP) flu Vaccination Programme in Wales. METHODS A longitudinal study was undertaken by secondary data analysis on data related to all NHS funded flu vaccinations administered in CP between 2012 and 2018 (n = 103941). Data were analysed using IBM SPSS® and Excel®. Pearson's correlation and independent sample t-test were conducted to compare the number of vaccines administered in CP vs overall numbers and those under 65 years and in the 'at risk' category in CP and GP respectively. Ethical approval was not required. RESULTS In total, pharmacists administered 103941 vaccinations. Vaccination numbers increased each season from 1568 in 2012/13 to 36238 in 2017/18. The main risk group was those aged 65 and over (59.9% of vaccinations). The proportion of those vaccinated who were aged <65 years and in an 'at risk' category was significantly higher in CP than GP (p < 0.01). There was a shift in balance between vaccinations administered by GPs and CPs in which CPs increased their share of all vaccinations in the flu programme from 0.3% in 2012-13 to 5.7% in 2017-18. A strong positive correlation was observed between increasing CP vaccinations and total vaccination numbers (R = 0.9316, p < 0.01). CONCLUSIONS Community pharmacists are providing increasing numbers of flu vaccinations in Wales, benefitting patients in all at-risk groups and reinforcing the valuable role of pharmacists at the heart of their communities, in terms of public choice and accessibility.
Collapse
Affiliation(s)
- Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3NB, UK.
| | - Andrew Evans
- Chief Pharmaceutical Officer, Welsh Government Offices, Cathays Park, Cardiff, CF10 3NQ, UK
| | - Sam Baker
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Keera Price
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| | - Cheryl Way
- National Pharmacy and Medicines Management Lead, NHS Wales Informatics Service, Cardiff, CF11 9AD, UK
| | - Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, King Edward VII Avenue, Cardiff, CF10 3NB, UK
| |
Collapse
|
30
|
Tzoupis H, Nteli A, Platts J, Mantzourani E, Tselios T. Refinement of the gonadotropin releasing hormone receptor I homology model by applying molecular dynamics. J Mol Graph Model 2019; 89:147-155. [DOI: 10.1016/j.jmgm.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
|
31
|
Le J, Mantzourani E, Desselle S, Lonie JM, Lucas C. Enhancing future pharmacy practice through integration of reflective practice strategies to embed self-development in a medication safety culture. Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2019.03.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Le J, Mantzourani E, Desselle S, Lonie JM, Lucas C. Utilisation of reflective practice strategies in healthcare clinical environments and implications for pharmacy practice. Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2019.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
33
|
Nazar H, Maniatopoulos G, Mantzourani E, Watson N. Consensus methodology to investigate appropriate referral criteria for inpatients to be offered a transfer of care service as they are discharged home. Integr Pharm Res Pract 2019; 8:35-37. [PMID: 31119095 PMCID: PMC6498952 DOI: 10.2147/iprp.s190008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | | | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - Neil Watson
- Pharmacy Services, Royal Victoria Infirmary NHS Hospital Trust, Newcastle upon Tyne, UK
| |
Collapse
|
34
|
Deslandes R, Lucas C, Hughes ML, Mantzourani E. Development of a template to facilitate reflection among student pharmacists. Res Social Adm Pharm 2017; 14:1058-1063. [PMID: 29233609 DOI: 10.1016/j.sapharm.2017.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Reflective practice activities utilizing appropriate tools enhance learning during and after experiential placements. Reflective tools described in the literature, used to support students on traditional placements of a duration of at least two weeks, sit at the unstructured end of a continuum (completely unstructured to just minimal structure). Additionally, non-traditional settings in role-emerging placements are of value as an alternative for experiential education. There were no reflective tools in the literature to provide a means of supporting pharmacy students as novice reflectors in non-traditional settings. OBJECTIVES To develop one fit-for-purpose tool that students could utilize across their experiences, regardless of type or duration of experiential placement. METHODS A multi-phased approach was adopted, including a mix of methodologies: interviews, focus groups, informal feedback from stakeholders, and grading reflective accounts utilizing Mezirow's categories of reflection. A range of stakeholders were involved at each stage to ensure the reflective tool was fit-for-purpose. These included students, placement preceptors, and academic staff acting as graders of student reflective accounts. RESULTS A total of 24 students participated in focus groups, 13 supervisors/preceptors engaged in interviews and informal feedback, and 853 student reflective accounts were graded, over 3 years. The final tool that has been developed and evaluated in this research supported students to develop to critical reflectors (6% - Phase 2 increased to 62.9% - Phase 3). CONCLUSIONS This novel and innovative approach supports novice reflectors, encourages reflection on action and enhances professional development. It is a structured yet flexible tool, for which there was a gap in the published literature. It can be utilized in varied placements in pharmacy curricula internationally.
Collapse
Affiliation(s)
- Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, Wales, UK.
| | - Cherie Lucas
- Graduate School of Health, University of Technology Sydney, 67 Thomas Street, Ultimo, Building 7, Sydney, NSW, 2007, Australia.
| | - Mary Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, Wales, UK.
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, Wales, UK.
| |
Collapse
|
35
|
Mantzourani E, Richards TG, Hughes ML. New roles in pharmacy - learning from the All Wales Common Ailments Scheme. Int J Pharm Pract 2015; 24:298-301. [PMID: 26670861 PMCID: PMC6084343 DOI: 10.1111/ijpp.12231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 09/14/2015] [Indexed: 11/27/2022]
Abstract
Objectives The objective of this study was to explore the perceptions of stakeholders on a national pilot of a new service, the ‘Choose Pharmacy’ Common Ailments Service (CAS) in Wales. Methods Methods used were semi‐structured interviews with stakeholders involved in development and delivery of the CAS. Snowball sampling was employed and invites were extended to eight of 13 pharmacies offering CAS in Cwm Taf LHB, the practice managers at two associated general practitioner surgeries and two local and national level commissioners. Key findings The benefits of encouraging self‐care by patients were widely recognised in terms of their impact on patients, health professionals and wider society. Although some challenges of introducing a new service were identified, these did not appear to be insurmountable. Conclusions CAS was welcomed by stakeholders in terms of its potential benefits. Results are therefore encouraging for policy makers involved in the implementation of other new roles within community pharmacy in the UK and beyond.
Collapse
Affiliation(s)
- Efi Mantzourani
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales
| | - Thomas Gwyn Richards
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales
| | - Mary Louise Hughes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales
| |
Collapse
|
36
|
Gillespie D, Hood K, Bayer A, Carter B, Duncan D, Espinasse A, Evans M, Nuttall J, Stanton H, Acharjya A, Allen S, Cohen D, Groves S, Francis N, Howe R, Johansen A, Mantzourani E, Thomas-Jones E, Toghill A, Wood F, Wigglesworth N, Wootton M, Butler CC. Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents. Age Ageing 2015; 44:853-60. [PMID: 26104506 DOI: 10.1093/ageing/afv072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/05/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown. AIM to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents. DESIGN AND SETTING a 12-month prospective cohort study in care homes across South Wales. METHOD antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic. RESULTS we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32). CONCLUSION residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.
Collapse
Affiliation(s)
- David Gillespie
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Antony Bayer
- School of Medicine, Cardiff University, Cardiff, UK
| | - Ben Carter
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Donna Duncan
- Nutrition and Dietetics, Abertawe Bro Morgannwg Health Board, Port Talbot, UK
| | - Aude Espinasse
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Meirion Evans
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Jacqueline Nuttall
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Arun Acharjya
- Virus Reference Department, Public Health England, London, UK
| | - Stephen Allen
- College of Medicine, Swansea University, Swansea, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Sam Groves
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Nick Francis
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Robin Howe
- Microbiology Unit, Public Health Wales, Cardiff, UK
| | | | | | - Emma Thomas-Jones
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Alun Toghill
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Neil Wigglesworth
- Welsh Healthcare Associated Infection Programme, Public Health Wales, Cardiff, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, Cardiff, UK
| | | |
Collapse
|
37
|
Hood K, Nuttall J, Gillespie D, Shepherd V, Wood F, Duncan D, Stanton H, Espinasse A, Wootton M, Acharjya A, Allen S, Bayer A, Carter B, Cohen D, Francis N, Howe R, Mantzourani E, Thomas-Jones E, Toghill A, Butler CC. Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes. Health Technol Assess 2015; 18:1-84. [PMID: 25331573 DOI: 10.3310/hta18630] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Antibiotic prescribing rates in care homes are higher than in the general population. Antibiotics disrupt the normal gut flora, sometimes causing antibiotic-associated diarrhoea (AAD). Clostridium difficile (Hall and O'Toole 1935) Prévot 1938 is the most commonly identified cause of AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting. OBJECTIVES The Probiotics for Antibiotic-Associated Diarrhoea (PAAD) study was designed as a two-stage study. PAAD stage 1 aimed to (1) prospectively describe antibiotic prescribing in care homes; (2) determine the incidence of C. difficile carriage and AAD (including C. difficile-associated diarrhoea); and (3) to consider implementation challenges and establish the basis for a sample size estimation for a randomised controlled trial (RCT) of probiotic administration with antibiotics to prevent AAD in care homes. If justified by PAAD stage 1, the RCT would be implemented in PAAD stage 2. However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2. DESIGN PAAD stage 1 was a prospective observational cohort study in care homes in South Wales with up to 12 months' follow-up for each resident. SETTING Recruited care homes had management and owner's agreement to participate and three or more staff willing to take responsibility for implementing the study. PARTICIPANTS Eleven care homes were recruited, but one withdrew before any residents were recruited. A total of 279 care home residents were recruited to the observational study and 19 withdrew, 16 (84%) because of moving to a non-participating care home. MAIN OUTCOME MEASURES The primary outcomes were the rate of antibiotic prescribing, incidence of AAD, defined as three or more loose stools (type 5-7 on the Bristol Stool Chart) in a 24-hour period, and C. difficile carriage confirmed on stool culture. RESULTS Stool samples were obtained at study entry from 81% of participating residents. Over half of the samples contained antibiotic-resistant isolates, with Enterobacteriaceae resistant to ciprofloxacin in 47%. Residents were prescribed an average of 2.16 antibiotic prescriptions per year [95% confidence interval (CI) 1.90 to 2.46]. Antibiotics were less likely to be prescribed to residents from dual-registered homes. The incidence of AAD was 0.57 (95% CI 0.41 to 0.81) episodes per year among those residents who were prescribed antibiotics. AAD was more likely in residents who were prescribed co-amoxiclav than other antibiotics and in those residents who routinely used incontinence pads. AAD was less common in residents from residential homes. CONCLUSIONS Care home residents, particularly in nursing homes, are frequently prescribed antibiotics and often experience AAD. Antibiotic resistance, including ciprofloxacin resistance, is common in Enterobacteriaceae isolated from the stool of care home residents. Co-amoxiclav is associated with greater risk of AAD than other commonly prescribed antibiotics. TRIAL REGISTRATION Current Controlled Trials ISRCTN 7954844. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 63. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kerenza Hood
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | - Jacqui Nuttall
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | - David Gillespie
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | | | - Fiona Wood
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Donna Duncan
- Abertawe Bro Morang University Health Board, Swansea, UK
| | - Helen Stanton
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | - Aude Espinasse
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | | | | | - Stephen Allen
- College of Medicine, Swansea University, Swansea, UK
| | - Antony Bayer
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Ben Carter
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - David Cohen
- Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK
| | - Nick Francis
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Robin Howe
- Public Health Wales Microbiology, Cardiff, UK
| | - Efi Mantzourani
- UK School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | | | | | | |
Collapse
|
38
|
Guillén S, Arredondo MT, Traver V, Valero MA, Martin S, Traganitis A, Mantzourani E, Totter A, Karefilaki K, Paramythis A, Stephanidis C, Robinson S. User satisfaction with home telecare based on broadband communication. J Telemed Telecare 2002; 8:81-90. [PMID: 11972942 DOI: 10.1258/1357633021937523] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Home telecare services based on broadband communication were established in five locations in Europe. Two different types of telecare unit were developed: one based on a PC or set-top box containing a videoconferencing codec and another on off-the-shelf videoconferencing units. The participants in the project were 13 medical staff, 135 patients and 88 people informally caring for the patients. Questionnaires were used to evaluate user satisfaction with eight telecare services. Almost all participants rated the usability of the system as good or excellent. A total of 105 telecare sessions were scored by the medical staff. Overall, the quality of audio and video communication was judged satisfactory. For the patients and carers, the perceived quality of communication was also satisfactory and did not vary significantly between sites. The medical staff were reasonably satisfied with how the service supported them in their work. Except for the item about being able to support patients in a critical situation, medical staff agreed that an improved quality of health services was offered through telecare. All participants agreed that personal information was treated confidentially and that there was little risk in using the telecare services. The medical staff trusted the assessments they could make remotely while using the telecare system. Although the findings cannot be generalized due to the small number of telecare sessions and the relatively short duration of the experiment, the results encourage further research.
Collapse
Affiliation(s)
- S Guillén
- BET Group, Universidad Politécnica de Valencia, Valencia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|