A novel behaviour change learning activity for pharmacy undergraduate students

Objectives: To engage students in a ‘behaviour change’ learning activity, applying health psychology theory to pharmacy practice in order to help students appreciate the challenges of behaviour change. Methods: Year 2 pharmacy students selected one behaviour to change and kept a diary for one-week before making changes. Students then received a health psychology lecture on behaviour change models. They instigated their behaviour change and continued to document this in the diary over a further one-week. Diaries were collected after the two-week activity for thematic analysis. Results: Of the 99 students, 61 (62%) submitted their completed diary, of whom 55 (90%) successfully implemented their behaviour change. These were categorised into four areas: diet, exercise, liquid consumption, and other. The remaining 10% provided reasons for not changing. Ten students (16%) described their behaviour using a psychological theory. Conclusions: Students engaged well with this novel learning activity, indicated by a high percentage diary completion. They demonstrated a clear appreciation of behaviour change within a real life context and its perceived relevance to pharmacy practice

Medicines prescribed by non-medical independent prescribers in primary care in Wales: a 10-year longitudinal study April 2011–March 2021

OBJECTIVES: The therapeutic classes of medicines prescribed by non-medical independent prescribers (NMIPs) working in primary care in Wales has not been studied in detail. The aim of this study was to conduct a 10-year longitudinal analysis of NMIP prescribing in Wales from April 2011 to March 2021. The study examined the British National Formulary (BNF) chapters from which medicines were prescribed by NMIPs, whether this changed over time, and whether there was variation in prescribing across the geographic regions of Wales. DESIGN: Retrospective secondary data analysis of primary care prescribing data. Monthly prescribing data for the 10 National Health Service financial years (April to March) from April 2011 to March 2021 were obtained from the Comparative Analysis System for Prescribing Audit software. Data were analysed according to BNF chapter, to identify in which therapeutic areas NMIPs were prescribing, and whether this changed over the study period. RESULTS: The number of items prescribed by NMIPs increased during the study period. From April 2011 to March 2021 prescribing in seven BNF chapters equated to approximately 80% of total items, with cardiovascular system medicines most prescribed. In the financial year 2011–2012 the BNF chapters with the greatest proportion of items prescribed were infection (18%) and respiratory system (13%), while in 2020–2021, these had changed to cardiovascular (23%) and nervous system (19%). The number of items prescribed in each health board in Wales varied, however, the BNF chapters contributing the largest percentages of items to the health board totals were broadly comparable. CONCLUSIONS: The BNF chapter with the most prescribed items changed from infection to cardiovascular during the study period, suggesting an increase in chronic disease management by NMIPs. The impact of this on the delivery of primary care services and patient outcomes is a focus for future work

An exploratory study of the patient experience of pharmacist supplementary prescribing in a secondary care mental health setting

Background: Management of chronic disease has become an increasing challenge to the National Health Service in the United Kingdom. The introduction of supplementary prescribing was seen as a possible mechanism to address the needs of this patient group. Individuals with mental illness were considered particularly suitable for management in this way. Objective: To explore the views and experiences of patients with mental illness on being managed by a pharmacist supplementary prescriber in a secondary care outpatient setting. Methods: A study of patient experiences utilising semi-structured interviews and self-completion diaries was adopted. Eleven patients participated in the study. Data were analysed utilising code and retrieve, and content analysis respectively. Results: Patients valued the increased accessibility to, and continuity of, their prescriber compared with their experience of other healthcare professionals. Patients reported they were able to trust the pharmacist’s knowledge of medication, were provided with sufficient information regarding reasons for treatment and side effects, and felt that they had an active role in decisions concerning their healthcare. Conclusions: This exploratory study showed that patients had positive views of being managed by a supplementary prescriber. However, it should be noted that the number of participants was small. It is therefore important that further, more wide ranging research is conducted to evaluate pharmacist prescribing within mental health settings

Prescribing trends over time by non-medical independent prescribers (NMIPs) in primary care settings across Wales (2011-2018): a secondary database analysis

Introduction: As of 2015, as part of the implementation of the Welsh Government primary care plan and primary care clusters, the Welsh Government has encouraged non-medical healthcare professionals working in primary care to train as independent prescribers (IPs). Objectives: This research aimed to identify the number of NMIPs in primary care in Wales and describe their prescribing trend of items between 2011 and 2018, in order to compare their prescribing pattern before and after the implementation of primary care clusters for Wales. Design: Retrospective secondary data analysis and interrupted time series analysis in order to compare prescribing by non-medical independent prescribers (NMIPs) preimplementation and postimplementation of primary care clusters across Wales. Results: Over the study period, 600 NMIPs (nurses n=474 and pharmacists n=104) had prescribed at least one item. The number of nurse IPs increased by 108% and pharmacists by 325% (pharmacists had the largest increase between July 2015 and March 2018). The number of items prescribed by NMIPs increased over time by an average of 1380 per month (95% CI 904 to 1855, p<0.001) after the implementation of primary care clusters compared with 496 (95% CI 445 to 548, p<0.001) prior its implementation. Approximately one-third of the items prescribed by NMIPs was within Betsi Cadwaladr University Health Board (HB) with only 4% in Powys Teaching HB. Conclusion: The number of NMIPs and their volume of prescribing in primary care in Wales has increased following the implementation of primary care clusters in 2015. This suggests that the Government’s recommendations of using NMIPs in primary care have been implemented. Future studies should focus on efficiency and quality of prescribing by NMIPs in primary care

Classic e-Delphi survey to provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services in Wales

Objective To provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services. Design Classic e-Delphi survey. Setting National study in Wales. Participants Pharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification. Results A total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences. Conclusion Given the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals

A novel behaviour change learning activity for pharmacy undergraduate students

Objectives: To engage students in a ‘behaviour change’ learning activity, applying health psychology theory to pharmacy practice in order to help students appreciate the challenges of behaviour change. Methods: Year 2 pharmacy students selected one behaviour to change and kept a diary for one-week before making changes. Students then received a health psychology lecture on behaviour change models. They instigated their behaviour change and continued to document this in the diary over a further one-week. Diaries were collected after the two-week activity for thematic analysis. Results: Of the 99 students, 61 (62%) submitted their completed diary, of whom 55 (90%) successfully implemented their behaviour change. These were categorised into four areas: diet, exercise, liquid consumption, and other. The remaining 10% provided reasons for not changing. Ten students (16%) described their behaviour using a psychological theory. Conclusions: Students engaged well with this novel learning activity, indicated by a high percentage diary completion. They demonstrated a clear appreciation of behaviour change within a real life context and its perceived relevance to pharmacy practice

Exposing pharmacy students to challenges surrounding care of young children via a novel role-emerging placement

Embedding opportunities for undergraduate pharmacy students to move between academic and practiceenvironments is key to transform their perception of patient care and to facilitate learning of the skills required forthe changing profession (Smith and Darracott, 2011). An approach adopted by many health care professions toprepare students for diversity with their field, is exposure to non-workplace environments in the form ofrole-emerging placements (REPs) (Whiteford and Wright St-Clair, 2002).The study presented is part of an ongoing action research project; this cycle focusses on exposing students tochallenges surrounding care of young children. Barriers and facilitators arising from an earlier pilot of REPs in theCardiff School of Pharmacy were considered when designing and implementing innovative placements for entrylevel pharmacy undergraduates in venues where mother and toddler groups were running. Students participated in apre-placement workshop where they explored a flexible list of questions to facilitate their interactions. Placementswere supervised by members of staff, who supported students throughout their experience and during a group debriefat the end of each session. Students were called to reflect further during a post-placement workshop with the rest oftheir colleagues.The full cohort of students submitted a copy of their overall reflections. Entries were analysed via thematic analysisto provide an overview. The sessions raised awareness of issues when providing pharmaceutical care to children andcontributed to students’ professional development. Challenges to their interactions were identified and suggestionsfor improvement were made. Results will inform structure and content of future REPs

Antibiotics for acute respiratory tract infections: a mixed methods study of patient experiences of non-medical prescriber management

ABSTRACT Objective: To 1) explore patients’ expectations and experiences of nurse and pharmacist non- medical prescriber led management of respiratory tract infections, 2) to examine whether patient expectations for antibiotics affect the likelihood of receiving them, and 3) to understand factors influencing patient satisfaction with respiratory tract infection consultations. Design: Mixed methods Setting: Primary care Participants: Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers. Results: Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by non-medical prescribers. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. ‘Patient-centred’ management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients’ expectation or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions, and lack of time restrictions, were each reported to contribute to patient satisfaction. Conclusion: Non-medical prescribers demonstrate an understanding of patient expectations of respiratory tract infection consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients’ expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by non-medical prescribers were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic, indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship

Same syllabus, different country - using DREEM to compare the educational environments at two pharmacy schools

A collaborative pharmacy programme between universities in Malaysia (Taylor’s, TU) and the UK (Cardiff, CU) saw its first students start in Malaysia in 2010. A modified version of the established DREEM (Dundee Ready Education Environment Measure) questionnaire was used to compare the two educational environments as perceived by the students