Editorial

Non

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention.

Hospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention. The process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach. Themes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity. This provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.(SK) This research was supported by Saudi Arabian Cultural Bureau in the UK and Umm Al-Qura University in Saudi Arabia, (Award/grant number: N/A). https://uksacb.org/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

A service evaluation and stakeholder perspectives of an innovative digital minor illness referral service from NHS 111 to community pharmacy.

The management of minor conditions represents a significant burden for urgent and emergency care services and reduces the capacity to provide specialist care for higher acuity healthcare need. A pilot Digital Minor Illness Service (DMIRS) was commenced in the North East of England in December 2017 to feasibility test the NHS 111 referral to community pharmacy for patients presenting with minor conditions. A formative evaluation of the service activity data and qualitative investigation of stakeholders involved in the service design, management, delivery and use, aims to present and investigate the service outcomes. Routine service activity data was evaluated during Jan-Dec 2018 to investigate the demographics of patients included in the service; the presenting conditions; and how those referrals were managed by community pharmacies. Semi-structured interviews with NHS 111 call handlers, project team members, community pharmacists and patients were undertaken to investigate the design, management, implementation and delivery of the service. 13,246 NHS 111 patient calls were referred to community pharmacy during the evaluative period. The most common presenting conditions were acute pain (n = 1144, 8.6%) and cough (n = 887, 6.7%). A large volume of complaints (47.1%, 6233) were resolved in community pharmacy. Stakeholders explained the structured approach to service design, organisation and implementation facilitated successful delivery and management. Patients reported positive experiences with accessing care via DMIRS. DMIRS demonstrated that patients could be referred to community pharmacy for the management of minor conditions, shifting a burden away from urgent and emergency care. The service data provides key information for further optimisation of service design, and stakeholder training and awareness. The service was acceptable and valued by patients. Evidence from the DMIRS pilot has been utilised to inform recent national healthcare policy and practice around the management of minor conditions within the urgent and emergency care setting.HN received funds to undertake evaluative work for the Digital Minor Illness Referral Service from NHS England (Grant number: BH181784). The funder provided support in the form of salaries for authors [HN], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ sectio

Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review.

Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions’ mechanisms of action and are more likely to result in effective and sustained interventions. To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed. Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework). This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development

Scope, content and quality of clinical pharmacy practice guidelines:a systematic review

Background Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published ina number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude todeveloping internationally acceptable common guidelines.Aim To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to qualitystandards as per the AGREE II instrument.Method Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for greyliterature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and anyclinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers usingthe English version of the AGREE II instrument.Results Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) andUSA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transi-tion of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the low-est score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development.Conclusion Clinical pharmacy guidelines development processes need to focus on all quality domains and should take asystematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical com-munication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographie

Scope, content and quality of clinical pharmacy practice guidelines:a systematic review

Background Guidelines for pharmacy practitioners regarding various clinical pharmacy activities have been published ina number of countries. There is a need to review the guidelines and identify the scope of activities covered as a prelude todeveloping internationally acceptable common guidelines.Aim To review the scope of clinical pharmacy guidelines and assess the extent to which these guidelines conform to qualitystandards as per the AGREE II instrument.Method Medline, Embase, Guideline Central, International Pharmaceutical Abstracts, Google Scholar and Google (for greyliterature) were searched for the period 2010 to January 2023. Guidelines which focused on any health care setting and anyclinical pharmacy activity were included. Data were extracted and quality assessed independently by two reviewers usingthe English version of the AGREE II instrument.Results Thirty-eight guidelines were included, mostly originating from Australia (n = 10), Ireland (n = 8), UK (n = 7) andUSA (n = 5). Areas covered included medication reconciliation, medicines optimisation, medication management and transi-tion of care. As per the AGREE II assessment, the highest score was obtained for the scope and purpose domain and the low-est score for rigour of development, mainly due to non-consideration of literature/evidence to inform guideline development.Conclusion Clinical pharmacy guidelines development processes need to focus on all quality domains and should take asystematic approach to guideline development. Guidelines need to further emphasise person-centred care and clinical com-munication. There is a scope to harmonise the guidelines internationally considering the diverse practices, standards and legislations across different geographie

Factors that influence patient and public adverse drug reaction reporting: a systematic review using the theoretical domains framework

Background: Only 5–10% of all adverse drug reactions (ADRs) are reported. Mechanisms to support patient and public reporting offer numerous advantages to health care systems including increasing reporting rate. Theory-informed insights into the factors implicated in patient and public underreporting are likely to offer valuable opportunity for the development of effective reporting-interventions and optimization of existing systems. Aim: To collate, summarize and synthesize the reported behavioral determinants using the theoretical domains framework (TDF), that influence patient and public reporting of ADRs. Method: Cochrane, CINAHL, Web of science, EMBASE and PubMed were systematically searched on October 25th, 2021. Studies assessing the factors influencing public or patients reporting of ADRs were included. Full-text screening, data extraction and quality appraisal were performed independently by two authors. Extracted factors were mapped to TDF. Results: 26 studies were included conducted in 14 countries across five continents. Knowledge, social/professional role and identity, beliefs about consequences, and environmental context and resources, appeared to be the most significant TDF domains that influenced patient and public behaviors regarding ADR reporting. Conclusion: Studies included in this review were deemed of low risk of bias and allowed for identification of key behavioural determinants, which may be mapped to evidence-based behavioral change strategies that facilitate intervention development to enhance rates of ADR reporting. Aligning strategies should focus on education, training and further involvement from regulatory bodies and government support to establish mechanisms, which facilitate feedback and follow-ups on submitted reports.Open Access funding provided by the Qatar National Library. This publication was made possible by the UREP award [UREP25-068-3-020] from the Qatar National Research Fund (a member of The Qatar Foundation)

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. This systematic review has been registered and published with Prospero ( CRD42020172773 )