Rose Tinted Glasses

How a lack of training is dissuading patients – and healthcare professionals – from the benefits of traditional herbal medicine

Pharmacy services and role development in UK general practice: a cross‐sectional survey

Background: The ‘Clinical Pharmacists in General Practice’ (CPGP) pilot provided a template for general practice pharmacy professionals’ (GPPPs) roles encouraging NHS England to fund >2000 practice‐based pharmacists. However, many GPPPs work outside the CPGP initiative and little is known about the services they provide. Objectives: To explore services provided by all UK GPPPs (pharmacists/pharmacy technicians), including the types of services, perceived benefits and barriers to role development. Methods: A 26‐item electronic questionnaire was developed using SurveyMonkey and piloted during cognitive interviews. A cross‐sectional survey was conducted via social media, primary care organisations and emails to CPGP pilot sites between November 2018 and March 2019. Three reminders were sent 1 week apart. Key findings: Ninety‐one complete responses were received (81 pharmacists; 10 technicians). Over 80% of pharmacists provided clinical services, such as medication reviews or management of long‐term conditions. More pharmacists within CPGP pilot managed repeat prescribing requests (P = 0.035). Technicians took responsibility for primarily non‐clinical roles, including commissioning or safety alerts/drug recalls. A third of GPPPs wished to develop care home services. Perceived benefits of GPPPs’ services included improved utilisation/development of professional skills, identifying medicines‐related issues and reduction in medication waste. Respondents were satisfied with professional relationships but reported workload issues, limited patient awareness of their roles and restricted opportunities to contribute to service development, which was associated with unsatisfactory support/mentorship (P < 0.001). Conclusion: General practice pharmacy professionals deliver clinical and non‐clinical services which may benefit patients, general practice and the healthcare system. General practices and national organisations should provide GPPPs with tailored support and exploit the combined strengths of pharmacists and pharmacy technicians to tackle increased workload

Pharmacists detecting atrial fibrillation in general practice: a qualitative focus group study

Background: Atrial fibrillation (AF) affects up to 10% of people aged ≥65 years, yet a third of all cases remain undetected. Practice-based pharmacists are in an ideal position to facilitate opportunistic AF screening, while increasing general practice capacity at a time of workforce crisis. Aim: To explore the perspectives of three stakeholder groups involved in the ‘Pharmacists Detecting Atrial Fibrillation’ (PDAF) study to elucidate the facilitators and barriers to pharmacist-led AF screening in general practice. Design & setting: A qualitative study took place, comprising homogeneous focus groups with stakeholders in Kent, UK. Method: The stakeholder groups — patients, general practice staff (GPS), and clinical pharmacists (CPs) — were recruited using convenience sampling. Audio-recordings were transcribed verbatim and analysed using a deductive Theoretical Domains Framework (TDF) approach. Results: Twenty-five patients, four pharmacists, and nine practice staff participated in six focus groups. Three main themes were identified: knowledge and awareness; prioritisation of resources; and environmental considerations. The public’s lack of awareness of AF-related risks and pharmacist-led screening services was highlighted. Practice-based pharmacists were perceived as an underutilised educational resource which, together with novel electrocardiogram devices, enabled convenient access to screening while reducing GPs’ workload. Participants agreed that AF screening should be incorporated into personalised health checks and at-risk groups should be prioritised, such as care home residents. Patients favoured the general practice environment over the community pharmacy where concerns of privacy, staffing, and commercialisation were raised. Conclusion: The findings of this study support the introduction of pharmacist-led AF screening programmes in general practice surgeries. Commissioners should consider the added value of utilising CPs and focus on the delivery of AF screening within an integrated service

Public’s perceptions of the emerging role of Cannabidiol (CBD) products

Cannabidiol (CBD) products, derived from hemp (Cannabis sativa) are becoming more popular as people seek alternative ways of managing their health; sales rose 333% in the US in 20181. The market value of CBD is estimated to be worth £1billion by 20252. The objectives were to explore the public’s perceptions and use of CBD products including where products are sourced, how knowledge is obtained and opinions on quality, safety and efficacy of CBD products. A questionnaire comprising open and closed questions was developed to consider quantitative and qualitative perspectives. An online platform, SurveyMonkey, was used to distribute the survey using social and professional networks (September - November 2019), which led to snowball sampling. A total of 596 responses were collected (63% female, 40% White-British) internationally. In total, 11% (n=66) claimed to use CBD products including oils, balm, tinctures and vapes for a range of ailments such as pain, stress and anxiety. Participants who did not personally use CBD products (n=530), 35% claimed they would like to try them, while 42% of participants knew of someone who was already using a CBD product for conditions such as arthritis and epilepsy and “generally improving quality of life”. Knowledge of CBD was commonly attributed to social media and news articles. Perception on safety and efficacy were positive with the notion of natural medicines being superior. Quality of products was associated with well-known brands or products which had a marketing authorisation; participants identified it was difficult to determine the quality of products brought online and better regulation is required. This study identifies that people continue to seek natural alternatives to supplement and maintain their health, thus the popularity of CBD continues to rise. The lack of clinical evidence to help make informed decisions about using CBD products needs to be addressed with more research

The Use of Traditional Herbal Medicines Amongst South Asian Diasporic Communities in the UK

Migrant South Asian communities in the UK have brought with them their own traditional forms of medicine, yet little is known about their current use of herbal medicines (HMs) in the UK. The aim of the study was to explore the origins, use and transmission of knowledge of traditional HMs used by diasporic South Asian communities in the UK. A researcher-administered questionnaire was used for data collection (n = 192). An opportunity sampling technique was used to recruit participants across several locations in Birmingham and Leicester. Two thirds of participants (n = 126) stated they used HMs to maintain their health and to treat various health conditions such as digestive problems, skin conditions and diabetes. Almost 2000 actively used HMs were documented including 123 plant species that were identified. Participants imported HMs from abroad as well as sourcing them locally and even growing some of their own plants. Up to 82% (n = 87) of participants who took prescription medicines did not tell their healthcare professionals about any HMs they consumed; this raises concerns about people’s knowledge of herb–drug interactions, compliance and effect on prescribed medicine regimens. Similar studies to explore the use of HMs by other ethnic groups are imperative to help optimise pharmaceutical care of patients

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: a cross-sectional feasibility study

Background: Growing prevalence of atrial fibrillation (AF) in the ageing population, and its associated life-changing health and resource implications, have led to a need to improve its early detection. Primary care is an ideal place to screen for AF, however this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care, makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over 65s for AF, using digital technology and pulse palpation during the influenza vaccination season. Methods and Findings: Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019 in four GP practices in Kent, UK. Pharmacists were trained by a cardiologist to pulse palpate, record and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years, attending an influenza vaccination clinic were offered a free heart rhythm check. 604 participants were screened (median age 73 years, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); older; have an increased BMI and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, previous Stroke, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% [95% CI: 56.4-91.0] and 92.2% [89.7-94.3], respectively. This rose to 88.5% (69.9-97.6) and 97.2% [95.5-98.4] with a SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and 3 (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. Conclusions: This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using a SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes

Product Design Education for Circular Economy

Design has continually developed new approaches to find the most appropriate solutions to the growing environmental and social problems. At the same time higher education courses have tried to adapt their curricula accordingly. The most recently proposed model is circular economy. It reinforces the idea of a paradigm shift to a system of closed loops where there is no waste. This article develops a state of the art on the integration of sustainability in product design in higher education and its evolution to embrace circular economy. This analysis includes identifying past experiences, which contents are addressed, what methodologies are used, what type of approach (focused or dispersed) and what are the needs for teaching staff. This paper tries to identify gaps in order to purpose better solution for circular economy integration.info:eu-repo/semantics/publishedVersio

Screening for atrial fibrillation within a South Asian community setting using single-lead ECG

Timely detection and treatment of AF is amongst the Government’s cardiovascular priorities. Several initiatives have demonstrated the potential of AF detection using single-lead electrocardiogram (SLECG) technology in primary care settings, such as general practitioners’ (GP) surgeries. Unfortunately, some AF patients, including those from ethnic minorities, may not routinely engage with main-stream healthcare and may go undetected. Compared to White British, South Asians have a higher prevalence of cardiovascular risk factors, however fewer are diagnosed with AF. This study aimed to ascertain the feasibility of opportunistic AF screening within a South Asian community delivered by supervised pharmacy undergraduates using SL-ECG devices

Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile® device: a comparative cross-sectional pilot study.

Atrial fibrillation (AF) is a major cause of stroke in older people. Exacerbated by age and co-morbidities, residents of care homes are more likely to develop AF and less likely to receive oral anticoagulants. To determine the prevalence of AF using the design and methodology of the Pharmacists Detecting Atrial Fibrillation (PDAF) study in a care home setting. A cross-sectional AF screening pilot study within four UK care homes, three residential and one residential/nursing. Screening followed the original PDAF protocol: a manual pulse check, followed by a single-Lead ECG ( ECG, AliveCor Kardia Mobile (KMD)) delivered by a pharmacist. All recorded ECG were reviewed by a cardiologist and any residents requiring follow-up investigations were referred to their general practitioner. Fifty-three of 112 care home residents participated. From 52 ECGs recorded, the cardiologist interpreted 13.5% (7/52) as having possible AF of which 9.6% (5/52) were previously unknown. One resident with previously unknown AF received anticoagulation. This study has shown a need for AF screening in care homes and that elements of the PDAF screening protocol are transferable in this setting. Early diagnosis and treatment of AF are essential to reduce the risk of stroke in this population. [Abstract copyright: © 2023. The Author(s).