Through the Looking Glass: Public and Professional Perspectives on Patient-centred Professionalism in Modern-day Community Pharmacy. Forum: Qualitative Social Research, 2009; 11. Panel 1: Interview questions related to pharmacy choice Why do you mainly go

Abstract: This paper presents five consultation workshops with 29 community pharmacists, stakeholders and patients that examined "patient-centred professionalism" in terms of pharmacists' working day and environment. The concept is ill-defined in both medical and pharmacy literature and the study aimed to clarify the situated nature of the term for patients and health professionals across settings. Workshops were supported by bio-photographic datasets of "in-situ" practice and Nominal Group Work. The thematic content analyses led to the following aspects: building caring relationships; managing external forces; the effects of space and environment, and different roles and expectations. The study reveals how patient-centred professionalism cannot be defined in any singular or stationary sense, but should be seen as a "moveable feast", best understood through everyday examples of practice and interaction, in relation to whose experience is being expressed, and whose needs considered. The phrase is being mobilised by a whole set of interests and stakeholders to reshape practice, the effect of which remains both uncertain and contested. Whilst patients prioritise a quick and efficient dispensing service from knowledgeable pharmacists, pharmacists rail against increasing public demands and overtly formalised consultations that take them away from the dispensary where the defining aspects of their professionalism lie

Method for aggregating the reporting of interventions in complex studies (MATRICS)

Background: The synthesis of findings from mixed methods studies can be difficult and complex, with many articles tending to report their results in parallel with little or no integration. Conclusions may be based on findings that disproportionally represent one aspect of the mixed methods design rather than using the findings of all the methods used in a balanced and robust manner (O’Cathain 2008). We have developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) in the context of a complex, multi-centre, mixed methods study to evaluate the modernisation of endoscopy services. Method: We listed the effects sought by the study (the aims and objectives), split according to effects on patients, on the NHS and on the rest of society and gave each a unique number. We then listed the methods used to explore those effects and gave each a unique letter. An alphanumeric code was devised to identify and link each effect with a method and vice versa. This code was applied to a comprehensive list of tabulated study findings so that each finding was linked with an effect and a method. All analogous findings were merged and the alphanumeric codes linked with those findings were listed alongside to illustrate that more than one aspect of the study reported that finding. All contradictory findings and their alphanumeric codes were listed separately but in adjacent rows in the table to indicate that different components of the study were not complementary in their findings. Discussion: The MATRICS allowed us to better synthesise and present a large number of findings, to illustrate all complementary findings across multiple research methods and to highlight where findings from different components of the study were contradictory. The MATRICS can be applied to other research on complex interventions using mixed methods with great effect

Narrating uncertainties about treatment of mental health conditions

Background: Integration of patient views in mental health service planning is in its infancy despite service provision being clearly dominated by narratives from professional consultations and medical records. We wished to clarify perceptions of uncertainty about mental health conditions from a range of provider and user perspectives (patients, carers, parents, mental health service providers) and understand the role of narratives in mental health research. Aims: (1) To explore the utility of qualitative research methods, particularly narrative content analysis in mental health research, and (2) identify aspects of uncertainty in mental health service users and providers. Material: Four hundred and six free text responses were considered as one element of an existing questionnaire about uncertainties about mental health treatments, collected from mental healthcare users and providers through charities, the Mental Health Research Network in Wales, health professionals and websites. Free text responses were analysed using narrative content analysis, an elaborate and rigorous research technique that involves groups of analysts working independently and together over extended group sessions. Findings: Three main themes emerged across respondent groups: "medication and treatment options", "objectification and marginalisation of patient" and "integrity of service delivery". Within these, patients embraced the opportunity to write about their illness at length, whilst carers' and parents' main concerns were about how patients were dealing with their illnesses, the services they were getting and the side effects of treatments. Carers and patients' parents perceived themselves to be the 'go-between', carrying messages between patients and professionals, in order to enable services to function. Mental health service providers and professionals considered uncertainties surrounding medication and treatment from an 'evidence-base' perspective, concentrating on medication choices and the adoption of new approaches to care rather than patient need and expectation. Patients wanted to know what alternatives were available to the drug regimes they were on and felt their opinions were rarely listened to. As a consequence patients felt marginalised by the health systems there to support them and by society as a whole. Conclusions: Narrative content analysis can help distil large amounts of free text data and enable their successful interpretation. Listening to patients' voices should become an integral part of routine service evaluation and may help bring patient expectation more in line with service organisation and delivery towards an optimal delivery of care.9 page(s