Deprescribing of Medicines in Care Homes - A Five-Year Evaluation of Primary Care Pharmacist Practices

(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines

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

The public's perception of the role of community pharmacists in Wales

Objective To investigate the general public's perceptions of the community pharmacist's (CP) role in Wales by exploring understanding, awareness of services provided and potential interventions for promoting the role of CPs. Methods Qualitative methodology using focus group (FG) discussions exploring opinions, facilitated by a moderator (pharmacist) and an assistant. Topics discussed included the following: what a CP does; reasons for visiting; from whom they seek advice on medicines or lifestyle issues; use of traditional and newer services and promotion of services. The groups, totalling 32 participants, represented non‐users and users of pharmacy services, that is pupils from a local secondary school (x1 group), people from the local community (x3) and patients plus carers from a Parkinson's disease group (x1). FG discussions were recorded and transcribed verbatim, and analysis was undertaken to identify themes. Key findings Traditional dispensing and supply of medicines roles were clearly recognised, but poor awareness of the newer services emerged, particularly in public health roles. CP's professionalism was acknowledged, but there was confusion over where they ‘fit’ within the National Health Service or with General Practitioners, with concerns or misconceptions raised over the impact of commercialism on professionalism. Conclusions Based on these findings, the public is accepting of the extended role of CPs and would engage with CPs for a wider range of services. However, there is a lack of awareness of what public health services are available. Considerable work is needed to increase public awareness, during the strategic development of these services in Wales

Diary study of adherence to antiretroviral therapy in people living with HIV

Background. Current empirical understanding of adherence to antiretroviral therapy (ART) is limited and the majority of current research is cross-sectional. Diary methodology provides an opportunity to capture the fluctuating nature of variables influencing adherence, close to the time that they occur. A limited number of diary studies have been conducted with people living with HIV (PLHIV) and few have investigated patterns of treatment adherence and psychological variables simultaneously. Aims. To investigate the day-to-day factors associated with adherence to ART in PLHIV. To investigate the feasibility of diary methodology used to investigate adherence to ART in PLHIV. Method. A mixed methods design comprising 2 parts was used: a diary study, using multilevel diary methodology (study 1) and qualitative semi-structured interviews (study 2). Study 1: participants (n = 18) completed an initial questionnaire, and a 14-day diary, the diary recorded adherence to ART and day-to-day variables (such as mood and stressors). Study 2: interviews were conducted with HIV service users (n = 4) and HIV healthcare staff (n = 5). The interviews explored factors influencing the general feasibility of diary methodology in HIV populations. Results. Full adherence (100%) was reported in terms of taking tablets, however, there was variability in reported adherence in terms of taking medication at the correct time (‘adherence timing’). Anticipatory negative affect associated with non-adherence and attitude (positive) towards treatment regime were the only two daily variables (measured in the diary) associated with optimal adherence timing. The relationships between adherence timing and the daily variables were moderated by a number of variables, including: illness perceptions, perceived stigma and beliefs about medications. The majority of participants who completed the diaries were male (88.9%) and white (72.2%), females and ethnic minority groups were under-represented. The interviews resulted in the identification of multiple barriers and facilitators of diary methodology in HIV populations. In particular, barriers to study uptake and completion were identified. Conclusions. A number of variables were found to be associated with optimal adherence timing. However, conclusions are limited due to the small sample size and under- representation of certain groups in the HIV population. Diary methodology may be more feasible within certain subgroups of the HIV population. Future research and clinical implications have also been considered

Pharmacy students' reflections on a 'mock medicines' activity: Exploring intentional and unintentional nonadherence

Objective. To engage pharmacy students in a ‘mock medicines’ teaching activity to increase their understanding of the patients’ perspectives of medicine-taking. To explore students’ awareness of intentional reasons for non-adherence. Methods. Students were given one of five different dosing regimes and asked to take the mock medicine (TicTacs©) over a one-week period. They completed a data capture form to log each dose taken or missed and provide reasons for this. An adherence score was calculated and all feedback transcribed for further analysis. Results. Seventy-six out of 115 students submitted forms, where adherence ranged from 4 to 100% (mean 88.7, SD=19.77). Nine factors relating to unintentional non-adherence were identified compared to only one for intentional non-adherence. Conclusions. Students engaged well with this activity showing a high percentage adherence but this was not related to the complexity of dosing schedule. Students demonstrated more awareness of the unintentional reasons for non-adherence than intentional

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

Pharmacy Technicians Roles and Responsibilities in the Community Pharmacy Sector: A Wales Perspective

(1) Background: Healthcare delivery models in Wales are changing in response to unprecedented pressure on the NHS. Community pharmacies will be prioritised to address public health and clinical needs at a local level. To support delivery of the new model, pharmacy technicians must be enabled and developed to optimize their roles. The aim of the study was to establish existing roles of pharmacy technicians working in the community pharmacy sector in Wales and to explore barriers and enablers to development. (2) Methods: A combination of quantitative and qualitative methodologies werewas used, with the main focus on quantitative methods. A total of 83 participants completed an online questionnaire and additional qualitative data were obtained from four semi-structured telephone interviews. (3) Results: The dispensing and final accuracy checking of medicines were reported as core functions of the community pharmacy technician role, with an average of 43% and 57% of time being spent on these roles respectively. There was some evidence of engagement in leadership and management roles (average of 19%) and limited evidence of delivery of services (average of 6%). (4) Conclusions: There is scope to enable community pharmacy technicians to optimize and further develop their roles. Enablers include the effective use of delegation, workplace support, improved staffing levels and prioritisation of extended pharmacy technician roles

Pharmacy students' reflections on a 'mock medicines' activity: Exploring intentional and unintentional nonadherence

Objective. To engage pharmacy students in a ‘mock medicines’ teaching activity to increase their understanding of the patients’ perspectives of medicine-taking. To explore students’ awareness of intentional reasons for non-adherence. Methods. Students were given one of five different dosing regimes and asked to take the mock medicine (TicTacs©) over a one-week period. They completed a data capture form to log each dose taken or missed and provide reasons for this. An adherence score was calculated and all feedback transcribed for further analysis. Results. Seventy-six out of 115 students submitted forms, where adherence ranged from 4 to 100% (mean 88.7, SD=19.77). Nine factors relating to unintentional non-adherence were identified compared to only one for intentional non-adherence. Conclusions. Students engaged well with this activity showing a high percentage adherence but this was not related to the complexity of dosing schedule. Students demonstrated more awareness of the unintentional reasons for non-adherence than intentional

The role of medication beliefs in COVID-19 vaccine and booster uptake in healthcare workers: An exploratory study

Illness and medication beliefs have shown to predict COVID-19 vaccination behaviour in the general population, but this relationship has yet to be demonstrated in healthcare staff. This research aimed to explore the potential explanatory value of illness and medication beliefs on the COVID-19 vaccination uptake of a sample of patient-facing healthcare workers (HCWs). A web-based questionnaire—measuring beliefs about vaccinations (the BMQ), perceptions of COVID-19 (the BIPQ), vaccine hesitancy, and vaccine uptake—was targeted to HCWs via social media platforms between May–July 2022. Open text responses allowed participants to provide explanations for any delay in vaccine uptake. A total of 91 participants completed the questionnaire. Most respondents (77.1%, n = 64) had received three doses of the COVID-19 vaccination, and vaccination uptake (number of doses received) was predicted by Vaccine Concerns, Vaccine Hesitancy, and their Necessity–Concerns Differential score. Vaccine Hesitancy was predicted by Necessity, Concerns, and Overuse scores, as well as Necessity–Concerns Differential scores. Delay in Vaccine Uptake could only be predicted for Dose 3 (Booster). Qualitative data revealed that hesitant respondents were “unable to take time off work” for vaccination and that some had concerns over vaccine safety. In conclusion, illness and medication beliefs have potential value in predicting vaccine hesitancy and uptake in healthcare workers. Interventions to improve vaccination uptake in this population should address concerns about vaccine safety and releasing staff for vaccination booster appointments should be prioritised. Future research should further investigate the relationship between illness and medication beliefs and COVID-19 vaccine uptake in a larger sample of healthcare workers