Co-morbidities as predictors of airflow limitation among smokers in England

The prevalence of co-morbidities among patients with Chronic Obstructive Pulmonary Disease (COPD) is well documented in the literature. Therefore, this pilot study aimed to identify whether co-morbidities screening would enhance COPD case-finding. Smoking patients were approached at Croydon University Hospital and two local community pharmacies (CPs). Their co-morbidities, respiratory symptoms, smoking pack-years and exercise capacity were collected. Airflow limitation was determined using handheld spirometry (COPD-6) device. The prevalence of airflow limitation was 42% (n = 21/50). The main identified predictors of airflow limitation were: co-morbidities (OR = 9, CI: 1.04–77.81, p = 0.025), respiratory symptoms (OR = 33.54, CI: 1.06–11.77, p = 0.039) and smoking history of ≥20 pack-years (OR = 3.94, CI: 1.13–13.64, p = 0.029). CPs were the main location for case-finding. This study demonstrated the need to screen for co-morbidities for COPD case-finding within CPs

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

BACKGROUND: Inhalation technique and medication adherence are highly important for the management of chronic obstructive pulmonary disease (COPD) since they are essential pre-requisites for achieving full therapeutic effect in patients. Community pharmacists are in the best position to deliver services in these two areas. METHODS: This is a ten-year period review of studies looking into the impact of community pharmacists in the management of COPD in relation to: inhalation technique and medication adherence in the period from 2005 to 2015. RESULTS: Ten studies are included in the review. The studies show that community pharmacists' interventions had a positive impact on improving patients' inhalation technique and adherence to inhaled medications. This was shown in some studies to be cost-effective in terms of reducing hospitalisation and severe exacerbation rate. Scarcity of studies in this domain is noted through this review. CONCLUSIONS: This review showed that community pharmacists can have a positive impact in the management of COPD especially on inhaler technique education and medication adherence. Nevertheless, their role is still not fully recognised in this area, thus there is a need for more research. There is also a need for more research to identify the optimal frequency for inhaler technique re-checking and education as a pre-emptive measure against technique deterioration in patients. The results highlight the need for healthcare systems to recognise more the role of community pharmacists in COPD management in two critical areas that are still challenging in real practice

Supporting respiratory patients in primary care : a qualitative insight from independent community pharmacists in London

COREQ checklist. (DOCX 20 kb

A qualitative study of Telehealth patient information leaflets (TILs) : are we giving patients enough information?

BACKGROUND: The provision of patient information leaflets regarding telehealth has been perceived by potential consumers as a strategy to promote awareness and adoption of telehealth services. However, such leaflets need to be designed carefully if adoption and awareness among potential users is to be promoted. Therefore, the aims of this study were: first, to see how telehealth was portrayed in some of the existing telehealth leaflets (THLs). Second, to explore patients' perceptions of the existing THLs and their engagement with the concept and how THLs can be optimised. METHODS: A two-step approach was employed to address the aims of this study. The first phase involved the use of discourse analysis to compare 12 electronically and publically available THLs, with the existing THL guidance "Involve Yorkshire and Humber". The second phase involved conducting 14 semi-structured interviews with potential telehealth users/patients to gauge their perception and engagement with the concept, using the two leaflets that were mostly matching with the guidance used. Six interviews were audio-recorded and eight had detailed jotted notes. The interviews were transcribed and thematically analysed to identify key themes. RESULTS: The discourse analysis showed certain gaps and variations within the screened leaflets when addressing the following aspects: cost of the telehealth service, confidentiality, patients' choices in addition to equipment use and technical support. Analysis of the interviews revealed patients' need for having clear and sufficient information about the telehealth service within the THLs; in addition to, patients' preference for the use of simpler terminologies for telehealth description and the provision of clear simple texts with pictorial presentations. The interviews also revealed certain limitations against adoption of telehealth by the participants, such as: lack of privacy and confidentiality of information, fear of technology breakdown and equipment failure, loss of face-to-face contact with healthcare professionals and being too dependent on the telehealth service. CONCLUSION: The current study showed a great variation among the screened THLs and highlighted certain gaps within the content and presentation of these leaflets. However, the study also highlighted certain key issues to be considered when designing THLs in the future to enhance telehealth uptake and use by patients

The holistic perspective of the INCISIVE project : artificial intelligence in screening mammography

Finding new ways to cost-effectively facilitate population screening and improve cancer diagnoses at an early stage supported by data-driven AI models provides unprecedented opportunities to reduce cancer related mortality. This work presents the INCISIVE project initiative towards enhancing AI solutions for health imaging by unifying, harmonizing, and securely sharing scattered cancer-related data to ensure large datasets which are critically needed to develop and evaluate trustworthy AI models. The adopted solutions of the INCISIVE project have been outlined in terms of data collection, harmonization, data sharing, and federated data storage in compliance with legal, ethical, and FAIR principles. Experiences and examples feature breast cancer data integration and mammography collection, indicating the current progress, challenges, and future directions

Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Knowledge and awareness of the general public and perception of pharmacists about antibiotic resistance

Background Antibiotic resistance (AR) continues to be a serious problem. Many factors contribute to AR, including inappropriate use of antibiotics, in which both healthcare professionals and patients play a contributing role. This study aimed to assess the awareness and knowledge of antibiotic usage and AR among the general public (in affluent and deprived areas) and community pharmacists' (CPs') in Greater London. Methods A cross-sectional survey involving members of the public was conducted between July 2014 and February 2015. Stage one involved members of the public (N = 384) residing in affluent areas of London. The second stage targeted public (N = 384) in deprived areas of London. In addition, CPs (N = 240) across the same areas were also surveyed. Data analysis was performed using Microsoft Excel and SPSS Software packages. Results Response rate: 36% (n = 139/384) and 57% (n = 220/384) and 25% (n = 60/240) of public residing in affluent areas, deprived areas and of CPs respectively was achieved. Definitive trends in knowledge of how antibiotics work could not be drawn to distinguish between affluent and deprived areas. However, public respondents residing in affluent areas possessed better understanding of AR and prudent use of antibiotics, and this was statistically significant in both cases (p < 0.05). Exposure to an antibiotic campaign (32% in affluent areas, 17% in deprived areas) did not raise public respondents' knowledge on AR and only partially raised their general knowledge on antibiotics usage. Only 20% of public residing in deprived areas received counselling from a CP, among them 74% had an antibiotic prescribed on at least one previous occasion. Those who received counselling displayed better knowledge about concordance/adherence with respect to antibiotic usage (p < 0.05) whereas exposure to an antibiotic campaign made no significant impact on knowledge about concordance/adherence. Conclusion The study highlights that there has been no change in the status quo with respect to awareness of antibiotic usage and AR even after the implementation of several awareness campaigns in England. Those who benefited from CP counselling showed a significant better knowledge towards prudent antibiotic usage which stresses the importance of CPs' counselling on antibiotic prescription

To examine the value of using an electronic monitoring device in optimising the role of community pharmacists in adherence and inhaler technique education in patients with chronic respiratory conditions

Over half of a billion people suffer from chronic respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). The two conditions are considered as major public health challenges with substantial clinical, social and economic burdens worldwide. The preferred route of treatment of these conditions is the inhalation route using inhaler devices. However, problems related to poor adherence and inhaler technique (IT) among respiratory patients are widely and historically reported in the literature and still represent a challenge for healthcare professionals (HCPs) and healthcare systems to date. In current practice, the most common used method to assess IT is the checklist method which is subjective and inaccurate. Similarly, the current most commonly used methods for assessing adherence to inhaled medications mainly involve self-reporting, medication refill and inhaler dose counters which are also known to suffer from lack of accuracy in assessing patient's actual medication taking behaviour. Thus, there has been a need for more accurate methods for assessing patients' adherence and IT. The use of electronic monitoring devices (EMDs) has been reported to be a more accurate solution for assessing patients' adherence and IT as opposed to the currently established methods. This thesis reports on the empirical research conducted in independent community pharmacies in England using a new EMD called the inhaler compliance assessment (INCA™) device that provides an objective monitoring of both adherence level and IT of respiratory patients while using their inhalers at home. The central aim of this thesis was to examine the potential of using the INCA™ device in optimising the role of community pharmacists (CPs) in adherence and IT education. The research first explored CPs' perceptions about their role in supporting asthma and COPD patients regarding adherence and IT and their need for novel technologies such as the INCA™ device to support patients. The research then examined the level of adherence and IT among a cohort of asthma and COPD patients using the INCA™ device in comparison to other established measures of adherence (dose counter, prescription refill and self reporting), in addition to the level of disease and self-management knowledge. Afterwards, the research determined the effect of a medicine use review (MUR) type consultation provided by CPs while incorporating objective tools mainly the INCA™ device and previous disease knowledge reults on patients' disease knowledge, adherence level and IT. Lastly, the research assessed the perceptions and acceptability of the INCA™ device among participating CPs and patients. Mixed research methods were employed for data collection, this involved face-to-face semi-structured interviews, questionnaires and objective monitoring of adherence and IT using the INCA™ device. At the first stage, 23 CPs were interviewed. The thesis findings suggested that CPs role in supporting respiratory patients was patchy and opportunistic, with the MUR service being the main form of support to this category of patients. Furthermore, the use of technology in supporting respiratory patients was very limited. Nevertheless, CPs were receptive and open to the idea of having the INCA™ device as a new technology to support patients, subject to funding and remunertation. Forty-eight COPD and asthma patients were monitered using the INCA™ device. The level of adherence and IT of patients as identified by the INCA™ device was significantly different and lower than that measured by the currently established methods of adherence assessment mainly the dose counter, medication refill and self-reporting, with an INCA™ actual adherence of 42.7% when incorporating IT errors and intervals between doses. Only 8 out of 48 patients used their inhaler correctly at the correct time, i.e. had an INCA™ actual adherence ≥80%. The median technique error rate (TER) per patient as determined by INCA™ device was 30.1%. The level of disease and self-management knowledge among COPD patients was assessed using the Bristol COPD knowledge questionnaire (BCKQ). For asthma patients, the level of disease knowledge was assessed using a synthesised asthma knowledge questionnaire based on the existing literature, whereas the level of self-management knowledge was assessed using the asthma self-management questionnaire (ASMQ). The results showed poor level of disease and self-management knowledge among COPD patients with a mean percentage score of 48.3% for the BCKQ, an adequate level of disease knowledge amng asthma patients with a mean percentage score of 67.5% for the synthesised asthma knowledge questionnaire and a poor level of self-management knowledge with a mean percentage score of 46.3% for the ASMQ. Next, 18 out of the 48 patients were followed-up and had a MUR type consultation with their CP through which discussion about adherence and IT was done using the feedback provided by the INCA™ device and disease knowledge using patients' disease knowledge results as acquired by the BCKQ, the synthesised asthma knowledge questionnaire and the ASMQ during the observational phase. The results indicated significant improvement in the INCA™ actual adherence from 30% to 68% (p=0.001) and significant reduction in TER from 51% to 12% (p=0.002), after conducting the MUR consultations. There was a significant improvement in level of disease and self-management knowledge among COPD patients from poor (median BCKQ percentage score 49.9%) to adequate (median BCKQ percentage score 62.3%) (p=0.003). There was also a significant improvement in level of disease knowledge among asthma patients from adequate (median sythesised asthma knowledge percentage score 65%) to good (median percentage score 85%) (p=0.031) and level of self-management knowledge from poor (median ASMQ percentage score 37.5%) to adequate (median ASMQ percentage score 75%) (p=0.027). Patients were receptive to the idea of monitoring their adherence and IT using the INCA™ device and to recommend the device to other patients. CPs advocated the introduction of the INCA™ devices into the care pathway of respiratory patients and its implementation in community pharmacies. In addition, the usability score for INCA™ device indicated a good passable score. However, CPs articulated several barriers, facilitators, and suggestions that need to be taken into consideration. Barriers include time, workload, funding, patients' attitudes and recruitment. Facilitators comprised funding and remuneration, commissioning, training, extra resources and involvement of other HCPs. In summary, the original contribution to knowledge in this research lies in the use of a new objective measure, the INCA™ device for the first time in England among patients recruited from independent community pharmacies. The use of this objective measure reflectd the magnitude of the problem of adherence and IT from a realistic point of view as opposed to clinical settings. Furthermore, embedding this objective measure as part of an MUR type consultation in England for the first time showed a significant positive impact in relation to patients' adherence level and IT