From hospital to home: a mixed methods exploration of post-discharge medicines management for older people living with long-term conditions

There are numerous threats to medication safety at care transitions, which are heightened for older people, because they live with multiple long-term conditions as well as polypharmacy, and have frequent hospital admissions. Whilst evidence of the severity and scale of these medicines-related problems exists, there is insufficient detail about the lived experience of post-discharge medicines management, in particular what helps or what hinders, and how better support could be enabled. This thesis, underpinned by the Medicines Research Council framework for complex intervention design, aimed to find acceptable intervention components, which would enhance patient experience. This research followed a sequential, mixed method design to: establish the evidence base through critical literature review, develop theory using an interview study grounded in behaviour change theory, and finally to model potential intervention components by expert consensus. Interviews revealed that there were gaps in current service provision, which impacted on participants’ knowledge of and capabilities with their medicines. Despite these challenges, some participants took actions to safeguard from problems after discharge. The literature review found that effective components of trialled interventions were self-management advice, post-discharge telephone follow up and medicines reconciliation. Further behaviour change techniques from the literature, alongside expert consensus and theory-driven analysis of interview findings resulted in final selection of eight potential components. Real-world implementation of these must be coupled with key changes to current healthcare practices and policy, including better engagement with patients and carers, as well as pro-active post-discharge follow-up. Future work must carefully explore how these components can be tested pragmatically

Introducing a pharmacy undergraduate student-led health check service at the University of Bradford

Ye

Exploring digital teaching tools, including the use of social media, to support teaching; perspectives of M.Pharm. students

Background: The School of Pharmacy and Medical Sciences, University of Bradford, is keen to evaluate the potential benefits of digital tools to enhance the teaching and learning of all M.Pharm. students. Students are increasingly using digital technology for both educational and social purposes (Cheston et al., 2013). This project explored the views of pharmacy students about digital technology, including social media, for teaching in the M.Pharm. programme. Method: Convenience sampling was employed to recruit M.Pharm. students for focus groups. Each focus group, facilitated by student researchers with topic guide, was audio-recorded and analysed for themes. Ethics approval was obtained from the University. Results: Year 2 and 3 students from two focus groups (n1=8 (6 male), n2=10 (8 male)) identified three main digital teaching tools used in the current programme: Blackboard, response clickers, and iSTAN. Blackboard, a virtual learning environment, was seen as a hub for holding all required learning materials. However, its use depended on internet access and some felt they would benefit from offline use and improved compatibility with different devices. Audience response systems and a human patient stimulator were well received by students. However, participants strongly felt that they were underutilised. The main benefit of using social media for learning was instant feedback and the encouragement of informal discussions. Participants were not always comfortable posting within the current digital tools used in the programme (e.g. Blackboard) as they felt ‘monitored’. However, participants acknowledged that information obtained through social media might not be as reliable as information from digital tools moderated by academics. Interestingly, participants reported a lack of engagement with programme specific social media pages (e.g. Facebook page). They felt that the information provided was aimed at qualified pharmacists, rather than current students. Conclusion: Participants valued accessibility, flexibility and availability of instant feedback when using digital tools to support their learning. They felt positive about the digital tools used within the programme but emphasised the need of greater integration. References Cheston, C.C., Flickinger, T.E. & Chisom, M.S. (2013). Social media use in medical education: a systematic review. Academic Medicine, 88(6), 893-90

Piloting an undergraduate student-led health check service

Ye

What health-related activities could be delivered by pharmacy students in the Digital Health Enterprise Zone (DHEZ) Academic?

yesBackground: Digital Health Enterprise Zone (DHEZ) Academic building opened in 2017 with the aim of improving outcomes of people living with long-term conditions. This multi-disciplinary facility houses: physiotherapy and optometry public clinics, health promotion areas, and digital diagnostics. Additionally, a medicines review hub with consultation rooms and teaching space was created for the School of Pharmacy and Medical Sciences (SPMS), University of Bradford. Pharmacy students have already successfully performed health-related activities with the public in international literature (Lawrence, 2018). This project explored SPMS academics’ perspectives on the potential use of the facility for the teaching and delivery of health-related activities by pharmacy students

Exploring the impact of Research Culture and Supervision on Post Graduate Researcher engagement within the School of Pharmacy

YesOriginally presented at the Pharmacy Education Conference. Jun 24, Manchester, UK

Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

YesBackground: medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results: twenty-four studies (total participants=17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone followup (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion: our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant PB-PG-0317-20010)

Examining the utility of the connect with pharmacy (CWP) intervention in reducing elderly readmission

YesConference abstract from the British Geriatrics Society Autumn Meeting, 14-16 Nov 2018, London, UK

Exploring the use of digital technology in the M.Pharm. programme to prepare students for their first day of practice

Background: Technological developments have facilitated the storage of patient records, enabled electronic prescribing, dispensing and the administration of medicines (Goundrey-Smith, 2014). These innovations are increasingly being used, requiring pharmacists to further develop digital capability. The School of Pharmacy and Medical Sciences, University of Bradford, is keen to explore ways to better equip M.Pharm. graduates with the necessary skills to confidently practise in the modern digital environment. This project explored student and staff perspectives of current digital teaching tools in relation to preparedness for the first day of practice

Post-discharge medicines management: the experiences, perceptions and roles of older people and their family carers

YesMultiple changes are made to older patients' medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post-discharge medicines management, for example medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. To explore the experiences of older patients and their family carers as they enacted post-discharge medicines management. Semi-structured interviews took place in participants' homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty-seven participants aged 75 plus who lived with long-term conditions and polypharmacy, and nine family carers, were interviewed. Three core themes emerged: impact of the transition, safety strategies and medicines management role. Conversations between participants and health-care professionals about medicines changes often lacked detail, which disrupted some participants' knowledge and medicines management capabilities. Participants used multiple strategies to support post-discharge medicines management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure medicines were supplied on time. The level to which they engaged with these activities varied. Participants experienced gaps in their post-discharge medicines management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about medicines changes and wider involvement of patients and family carers in their medicines-related care during the hospital-to-home transition.This work was supported by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). This independent research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0317-20010)