7 research outputs found
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Capturing pharmacists' impact in general practice: an e-Delphi study to attempt to reach consensus amongst experts about what activities to record
Background: In the UK, there is ongoing integration of pharmacists into general practice as a new healthcare service in primary care. Evaluation of the service involves national measures that require pharmacists to record their work, on the general practice clinical computer systems, using electronic activity codes. No national agreement, however, has been established on what activities to record. The purpose of this study was to attempt to reach consensus on what activities general practice-based pharmacists should record.
Methods: The e-Delphi method was chosen as it is an excellent technique for achieving consensus. The study began with an initial stage in which screening of a general practice clinical computer system and discussion groups with pharmacists from two âpharmacists in general practiceâ sites identified 81 codes potentially relevant to general practice-based pharmacistsâ work. Twenty-nine experts (pharmacists and pharmacy technicians from the two sites along with experts recruited through national committees) were then invited by e-mail to participate as a panel in three e-Delphi questionnaire rounds. In each round, panellists were asked to grade or rank codes and justify their choices. In every round, panellists were provided with anonymised feedback from the previous round which included their individual choices along with their co-panellistsâ views. Final consensus (in Round 3) was defined as at least 80% agreement. Commentaries on the codes from all e-Delphi rounds were pooled together and analysed thematically.
Results: Twenty-one individual panellists took part in the study (there were 12 responses in Round 1, 18 in Round 2 and 16 in Round 3). Commentaries on the codes included three themes: challenges and facilitators; level of detail; and activities related to funding. Consensus was achieved for ten codes, eight of which related to activities (general and disease specific medication reviews, monitoring of high-risk drugs and medicines reconciliation) and two to patient outcomes (presence of side effects and satisfactory understanding of medication).
Conclusions: A formal consensus method revealed general practice-based pharmacistsâ preferences for activity coding. Findings will inform policy so that any future shaping of activity coding for general practice-based pharmacists takes account of pharmacistsâ actual needs and preferences
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Patientsâ experiences of pharmacists in general practice: an exploratory qualitative study
Background: Since 2015, pharmacists have been integrating into English general practices and more recently into primary care networks. General practice-based pharmacists provide a range of patient-facing services, such as medication reviews, management of long-term conditions and minor ailments, prescribing duties and answering queries over the telephone. Literature reports patientsâ satisfaction with general practice-based pharmacistsâ services, however, previous research captured only limited experiences. The aim of the current study was to pursue an extensive exploration of patientsâ experiences of pharmacists in general practice.
Methods: General practice-based pharmacists, working in practices in West London, Surrey and Berkshire, handed invitation packs to patients seen during consultations. Patients that wanted to take part in the study were invited to undertake a qualitative, in-depth, face-to-face, semi-structured interview within the practice with which each patient was registered. Interviews lasted from 15 minutes to more than one hour and were audio-recorded. Recruitment continued until data saturation. Audio-recordings were transcribed verbatim and transcripts analysed thematically.
Results: Twenty participants were interviewed. Four themes were discerned: awareness (âI had been coming to this practice for 24 years and I didnât know that there was a pharmacistâ); accessibility (âPeople ring for a GP [general practitioner] appointment ⊠itâs Monday and they [receptionist] tells you âWe can slot you in on Fridayâ ⊠with a pharmacist on board, they can [instantly] look at youâ); interactions (âIâve always had a really good interaction with them [pharmacists] and they listen and they take on board what Iâm trying to sayâ); and feedback (âItâs easier [to collect feedback instantly] because I could have forgotten half of what they [pharmacists] have told me in an hour or soâs timeâ).
Conclusions: Findings indicate that pharmacistsâ integration into general practices could improve accessibility to, and the quality of, care received. The findings will assist policy development to provide general practice-based pharmacistsâ services as per patientsâ needs
Non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma: protocol
Introduction: In the UK, approximately 4.3 million adults have asthma, with one-third experiencing poor asthma control, affecting their quality of life, and increasing their healthcare use. Interventions promoting emotional/behavioural self-management can improve asthma control and reduce comorbidities and mortality. Integration of online peer support into primary care services to foster self-management is a novel strategy. We aim to co-design and evaluate an intervention for primary care clinicians to promote engagement with an asthma online health community (OHC). Our protocol describes a âsurvey leading to a trialâ design as part of a mixed-methods, non-randomised feasibility study to test the feasibility and acceptability of the intervention. Methods and analysis: Adults on the asthma registers of six London general practices (~3000 patients) will be invited to an online survey, via text messages. The survey will collect data on attitudes towards seeking online peer support, asthma control, anxiety, depression, quality of life, information on the network of people providing support with asthma and demographics. Regression analyses of the survey data will identify correlates/predictors of attitudes/receptiveness towards online peer support. Patients with troublesome asthma, who (in the survey) expressed interest in online peer support, will be invited to receive the intervention, aiming to reach a recruitment target of 50 patients. Intervention will involve a one-off, face-to-face consultation with a practice clinician to introduce online peer support, sign patients up to an established asthma OHC, and encourage OHC engagement. Outcome measures will be collected at baseline and 3 months post intervention and analysed with primary care and OHC engagement data. Recruitment, intervention uptake, retention, collection of outcomes, and OHC engagement will be assessed. Interviews with clinicians and patients will explore experiences of the intervention. Ethics and dissemination: Ethical approval was obtained from a National Health Service Research Ethics Committee (reference: 22/NE/0182). Written consent will be obtained before intervention receipt and interview participation. Findings will be shared via dissemination to general practices, conference presentations and peer-reviewed publications. Trial registration number: NCT05829265
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How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems
Background: In England, there is an ongoing national pilot to expand pharmacistsâ presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacistsâ impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when
measuring and recording their impact in general practice.
Methods: All pharmacists, general practitioners (GPs) and practice managers working
across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured
focus groups, each lasting approximately one hour, to explore experiences and
perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and
the data analysed thematically. Results: In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs (âwhether or not we actually have positive impact on KPIs is beyond our controlâ); depth and breadth of pharmacistsâ activity (âwe see a huge plethora of different patients and go through this holistic approach - everything is looked atâ); awareness of practice based pharmacistsâ roles (âI think the really important [thing] is that everyone knows what pharmacists in general practice are doingâ); and central evaluation versus local initiatives (âthe KPIs will be measured by National Health Service England regardless of what we thinkâ versus âwhat I think is more pertinent, are there some local things weâre going to measure?â). Conclusions: Measures that will effectively capture pharmacistsâ impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacistsâ activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacistsâ presence in general practice
Data supporting the article âPatientsâ experiences of pharmacists in general practiceâ
This dataset contains the raw data from one interview study to explore patient experiences of pharmacists in English general practices. The dataset contains the transcripts from patient interviews and the study's Consent Form
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Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care
Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics
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Non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma: protocol.
Peer reviewed: TrueAcknowledgements: We would like to thank all PCTU staff at QMUL for their input and assistance in developing the data management and statistical analysis plans in this study protocol. Sincere thanks are also owed to our various partners, including AUKCAR for adopting the study and eagerly supporting the study through its PPI group; and Asthma + Lung UK and HealthUnlocked, our charity and industry partners, respectively, for their support in designing the operational aspects of the intervention and collection of OHC data.INTRODUCTION: In the UK, approximately 4.3âmillion adults have asthma, with one-third experiencing poor asthma control, affecting their quality of life, and increasing their healthcare use. Interventions promoting emotional/behavioural self-management can improve asthma control and reduce comorbidities and mortality. Integration of online peer support into primary care services to foster self-management is a novel strategy. We aim to co-design and evaluate an intervention for primary care clinicians to promote engagement with an asthma online health community (OHC). Our protocol describes a 'survey leading to a trial' design as part of a mixed-methods, non-randomised feasibility study to test the feasibility and acceptability of the intervention. METHODS AND ANALYSIS: Adults on the asthma registers of six London general practices (~3000 patients) will be invited to an online survey, via text messages. The survey will collect data on attitudes towards seeking online peer support, asthma control, anxiety, depression, quality of life, information on the network of people providing support with asthma and demographics. Regression analyses of the survey data will identify correlates/predictors of attitudes/receptiveness towards online peer support. Patients with troublesome asthma, who (in the survey) expressed interest in online peer support, will be invited to receive the intervention, aiming to reach a recruitment target of 50 patients. Intervention will involve a one-off, face-to-face consultation with a practice clinician to introduce online peer support, sign patients up to an established asthma OHC, and encourage OHC engagement. Outcome measures will be collected at baseline and 3âmonths post intervention and analysed with primary care and OHC engagement data. Recruitment, intervention uptake, retention, collection of outcomes, and OHC engagement will be assessed. Interviews with clinicians and patients will explore experiences of the intervention. ETHICS AND DISSEMINATION: Ethical approval was obtained from a National Health Service Research Ethics Committee (reference: 22/NE/0182). Written consent will be obtained before intervention receipt and interview participation. Findings will be shared via dissemination to general practices, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05829265