Perceived roles and barriers in caring for the people who are homeless:a survey of UK community pharmacists

Background: Community pharmacists can be an accessible source for advice and support for the people who are homeless, given their utilisation of a variety of currently available services such as dispensing of medicines, drugs and alcohol services. Objective: To determine community pharmacists’ training, experiences and behavioural determinants in counselling and management of homeless population. Setting: UK community pharmacies. Method: A questionnaire based on literature and theoretical domains framework was mailed to randomly sampled community pharmacies in England and Scotland (n = 2000). Data were analysed using descriptive and inferential statistics. Main outcome measures: Pharmacists’ perspectives, pharmacists’ training, pharmacists’ experiences and behavioural determinants. Results: A total of 321 responses (RR 16.1%) were received. Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients. Less than a third (n = 101, 32.2%) indicated that they knew where to refer a homeless patient for social support. Broaching the subject of homelessness was outside their comfort zone (n = 139, 44.3%). Only four (1.2%) respondents could correctly answer all knowledge assessment questions. Conclusions: Community pharmacist identified lack of education, training opportunities and guidelines in counselling and management of homeless patients. Targeting community pharmacists’ knowledge, skills and intention to provide care to the homeless patients may enable addressing health inequality through community pharmacy

Development of a tool to support community pharmacy engagement with patients who may be homeless.

Background: Homelessness remains a global public health concern. A prior survey indicated the need for pharmacist training and coverage of the topic of homelessness around minimising impact of medicines use, referring for social support, confidence in broaching the subject with patients, support and guidelines for practice. Purpose: To further explore community pharmacists' views on the need for, type and content of a tool to support their engagement with patients who may be homeless. Methods: A semi-structured interview schedule was developed based on existing literature, survey results and theoretical frameworks (Theoretical Domains Framework; COM-B model) Community pharmacists from England and Scotland who had taken part in a survey consented to take part in a follow-on, digitally recorded telephone interview. Each was transcribed then coded using a framework approach. Ethical approval had been gained. Results: Interviews (n=15) conducted November-December 2017 found all participants felt capable and were motivated to improve their approach when engaging with patients who may be experiencing homelessness. They welcomed the opportunity to contribute to the content and format of a support tool. They also thought the topic should be better covered at undergraduate and continuing professional development. Some suggested role play to improve confidence and all felt capable if provided with up-to-date information on local homelessness support services. Conclusions: Community pharmacists are capable, motivated and have the opportunity to better engage with patients considered to be homeless. However, this was a small cohort and further research is indicated to inform support tool design

Pharmacists' training, experiences and behaviours in managing homeless patients.

Community pharmacists are well-situated to offer proactive and opportunistic support and advice to the homeless. The aim of this research was to investigate pharmacists' training, experiences and behaviours in managing homeless patients. A questionnaire using both open and closed questions was developed, based on existing literature, researcher expertise and the Theoretical Domains Framework (TDF) - a synthesis of behaviour change theory. The TDF outlines fourteen individual domains perceived to influence behaviour, including knowledge, skills, beliefs about capabilities and social influences. The questionnaire was reviewed and piloted with fifty pharmacists, and NHS R&D approval was obtained. The questionnaire was then sent to a random sample of 1,951 community pharmacies in England and Scotland, with two follow-up reminders. Results were analysed using descriptive statistics. 321 responses (response rate 16.5%) were received. The mean (SD) age of respondents was 39 (plus or minus 12) years with a third (n=94, 29.3%) having been qualified as a pharmacist for fewer than five years. Many respondents (n = 187) reported having managed a homeless patient in their pharmacy, with approximately 17% (n=53) saying that this was a daily activity. The majority (n=242, 75.4%) of participants said that homelessness was not included in their undergraduate, postgraduate or continuous professional development (CPD) pharmacy training (n=225, 70.1%). Only a third (n=100, 31.1%) agreed or strongly agreed that they knew to whom they should refer a homeless patient for social support. Approximately 42% (n=137) indicated they would discuss homelessness only if raised by the patient. Only one fifth (n=71, 22.1%) felt comfortable advising homeless patients on how to minimise the impact of homelessness on their medication use, and the vast majority of respondents reported a lack of clear guidelines (n=294, 94.2%). The results of this study suggest lack of appropriate opportunities - at undergraduate, postgraduate and CPD level - for training on how to manage homeless patients. There is a need to develop guidelines that will enable community pharmacists to better support homeless patients in alleviating the impact of homelessness; these guidelines should include advice on the pharmacist's role in supporting homeless medicine management and providing signposting to appropriate social services

Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study.

Background: - The relocation of formerly homeless patients eligible to transfer from a specialist homeless healthcare centre (SHHC) to mainstream general practices is key to patient integration in the local community. Failure to transition patients conferring eligibility for relocation may also negatively impact on SHHC service delivery. Aim: - To explore barriers and facilitators of relocation from the perspectives of formerly homeless patients and healthcare staff involved in their care. Design and setting: - Qualitative semi-structured face-to-face and telephone interviews conducted in the north east of Scotland. Method: - Participants were patients and healthcare staff including GPs, nurses, substance misuse workers, administrative, and local community pharmacy staff recruited from one SHHC, two mainstream general practices, and four community pharmacies. Interview schedules based on the 14 domains of the Theoretical Domains Framework (TDF) were drafted. Transcripts of the interviews were analysed by two independent researchers using a framework approach. Results: - Seventeen patients and 19 staff participated. Key barriers and facilitators aligned to TDF domains included: beliefs about consequences regarding relocation; patient intention to relocate; environmental context and resources in relation to the care of the patients and assessing patient eligibility; patient skills in relation to integration; social and professional role and identity of staff and patients; and emotional attachment to the SHHC. Conclusion: - Implementation of services, which promote relocation and integration, may optimise patient relocation from SHHCs to mainstream general practices. These include peer support networks for patients, better information provision on the relocation process, and supporting patients in the journey of identifying and adjusting to mainstream practices

Methodological considerations in clinical outcomes assessment of pharmacy-based minor ailments management : A systematic review

Data Availability: All relevant data are within the paper and its Supporting Information files. Protocol is available to access online through Centre for Review and Dissemination. Funding: This study was funded by the European Society of Clinical Pharmacy Research Grant award 2016. The funding body had no role in the design of the study, data collection, analysis, and interpretation of data and in writing the manuscript.Peer reviewedPublisher PD

Supporting shared decision-making and people’s understanding of medicines : An exploration of the acceptability and comprehensibility of patient information

ACKNOWLEDGEMENTS The research team would like to thank the community pharmacy management and staff for all their assistance in facilitating recruitment. Thanks also to our colleague Alyson Brown, Robert Gordon University, for her help with recruitment and to Linda Collins, Healthcare Improvement Scotland, for assisting with project materials. We are incredibly grateful to all participants who gave up their time to participate in the research and who provided such valuable feedback.Peer reviewedPublisher PD

The experiences and beliefs of older people in Scottish very sheltered housing about using multi-compartment compliance aids

Acknowledgements The research team gratefully acknowledge all research participants, Rory Lynch for comments on study design and Jeanette Lowe for transcribing all the interviews. Funding This work was supported by research funding from Aberdeen City Community Health Partnership. The funder who played no role in the design, execution, analysis and interpretation of data, or writing of the study.Peer reviewedPublisher PD

Exploring the role of pharmacy teams in Scottish GP practice: an interim analysis.

Background: Scottish Government policy has highlighted the potential contribution of pharmacy teams, comprising pharmacists and pharmacy technicians, in GP practices in Scotland. Purpose: To explore the role of pharmacy teams in GP practices in Scotland. Methods: An online questionnaire was developed, piloted and the link sent out by email from a nominated contact in each of the 14 Scottish Health Boards to all pharmacists and pharmacy technicians working in GP Practices with two reminders at fortnightly intervals. Ethical approval had been gained. Results: Response rates for pharmacists were 83.4% (393/471) and pharmacy technicians, 89.4% (101/113). The majority of pharmacists and pharmacy technicians were aged between 30 and 49 years (n=248, 63.1%; n=68, 67.3% respectively) and had been qualified for 20 or more years (n=164, 41.7%, n=35, 34.7% respectively). Pharmacists reported working in up to 29 GP Practices (Median=2) and pharmacy technicians across 1 to 54 (Median=5). Pharmacists were undertaking medication/polypharmacy reviews face-to-face (n=231, 58.8%), notes only (n=159, 40.5%) and via telephone/video (n=104, 26.5%). Over 70% were currently undertaking prescribing efficiency work (n=297, 75.6%) and interpreting prescribing data (n=283, 72.0%). Pharmacy technicians were undertaking medication/polypharmacy reviews face-to-face (n=7, 6.9%), notes only (n=36, 35.6%) and via telephone/video (n=2, 2.0%). In addition, over 70% were currently undertaking prescribing efficiency work (n=80, 79.2%) and prescribing management processes (n=80, 79.2%). Conclusions: The findings illustrate the depth of the pharmacy workforce and diversity of roles of those employed in GP practices

Supporting shared decision-making and people’s understanding of medicines: An exploration of the acceptability and comprehensibility of patient information

Background: Patient information may assist in promoting shared decision-making, however it is imperative that the information presented is comprehensible and acceptable to the target audience. Objective: This study sought to explore the acceptability and comprehensibility of the ‘Medicines in Scotland: What’s the right treatment for you?’ factsheet to the general public. Methods: Qualitative semi-structured telephone interviews were conducted with members of the public. An interview schedule was developed to explore the acceptability and comprehensibility of the factsheet. Participants were recruited by a researcher who distributed information packs to attendees (n=70) of four community pharmacies. Interviews, (12-24 minutes duration), were audio recorded, transcribed verbatim and analysed using a framework approach. Results: Nineteen participants returned a consent form (27.1%), twelve were interviewed. Six themes were identified: formatting of the factsheet and interpretation; prior health knowledge and the factsheet; information contained in the factsheet; impact of the factsheet on behaviour; uses for the factsheet; and revisions to the factsheet. Conclusions: The factsheet was generally perceived as helpful and comprehensive. It was highlighted that reading the leaflet may generate new knowledge and may have a positive impact on behaviour

An evaluation of mental health clinical pharmacist independent prescribers within general practice in remote and rural Scotland.

Background: A 12-month pilot was implemented in two general practices in remote and rural Scotland, with patients referred by general practitioners to specialist mental health pharmacist independent prescribers. Objective: The objective was to evaluate the pilot service from the perspectives of the patients and the care team. Methods: The pharmacists routinely recorded patient-specific data of all clinical issues and their actions at the time of each consultation. Further datasets comprised baseline and follow-up Patient Health Questionnaire (PHQ-9) and/or Generalised Anxiety Disorder (GAD-7) rating scales, a patient survey and interviews with members of the care team. Results: Of the 75 patients, two-thirds (n=47, 62.7%) were referred with a diagnosis of mixed depression and anxiety. There were 324 consultations (median 3, IQR 2–5, range 1–14) and 181 prescribing actions. At pilot completion, 34 patients (45.3%) had PHQ-9 and/or GAD-7 scores reduced by 50%. Patient questionnaires and staff interviews generated positive responses. Conclusion: This pilot has provided evidence that specialist mental health pharmacist independent prescribers delivered quality care to patients with diagnoses of moderate to severe depression and/or anxiety. Whilst accepting study limitations, there is potential to translate the pilot model of care to sustained services throughout general practice