A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation

The authors would like to thank all participants in this research for their valuable input into the co-design process.Background: Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF. Methods: A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacybased health programs was used to build a theoretical model of the service. Results: Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.). Conclusion: A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting.This work was funded by Covidien Pty Ltd. (Medtronic Australasia Pty Ltd) [UTS Project code: PRO16–0688], which is the company that has the rights to distribute the device Microlife BP A200 AFIB in Australia. Also, funding for this research has been provided by a UTS Chancellor’s postdoctoral fellowship awarded to the first author of this article (ID number: 2013001605)

Children of Prisoners: Their Situation and Role in Long-Term Crime Prevention

Studies suggest that maintaining family ties can help reduce the likelihood of reoffending, and that while parental imprisonment can increase a child’s likelihood to offend, positive responses to the situation can aid the children’s well-being, attitude and attainment. Drawing on findings from the recently completed EU-funded COPING Project on the mental health of children of prisoners, this chapter explores the factors that aid a child’s ability to cope with parental imprisonment and the actions that different stakeholders can take to support them. It identifies some of the mental health impacts at different stages of parental imprisonment, the roles played by non-imprisoned parents/carers and by schools, and suggests options for further clarifying the factors that help and hinder children of prisoners in the short and long term

Children’s Experiences of Contact with Imprisoned Parents: A Comparison between Four European Countries

Across the European Union an increasing number of children are experiencing parental imprisonment and the adverse emotional, behavioural and social outcomes that it entails. Separation due to imprisonment also places strain on parent-child relationships, with children reporting feelings of abandonment and alienation, and difficulties communicating with their imprisoned parent. This paper presents findings from interviews with a total of 135 families in the UK, Germany, Romania and Sweden. There were noticeable country differences in the practical and financial barriers to maintaining contact and the suitability of prison visiting environments. This had important implications for children’s emotional health and the extent to which contact was conducive to supporting parent-child relationships

Travelling with multiple medicines: a source of medication error and non-adherent ‘forgetting’

One commonly cited reason for medication non-adherence and errors is ‘forgetting’ to take medicines. Research has identified the difficulty of remembering to take medicines whilst away from home, yet little in-depth research exists that explores people’s own perspectives. This study examined the experiences of people taking multiple medicines to improve understanding of their daily use and management. Methods Participants were 34 Australians taking 5+ prescription or over-the-counter medicines, recruited through GPs, pharmacies, e-newsletters, consumer organisations and snowballing. Semi-structured narrative interviews explored: multiple medicines use, medicines management, maintaining usual life, and messages for others taking multiple medicines. Interviews were video- and/or audio-recorded and transcribed verbatim. Constant comparative thematic analysis was conducted. Results Travel was a key reason for forgetting to take medicines and making mistakes. Overseas travel and complex regimens posed particular challenges, such as crossing international datelines and maintaining medication routines when other daily routines were suspended. Packing medicines was complex, time-consuming and vulnerable to mistakes. The main challenges in travelling with medicines included: packing the correct doses for the period of travel; storage; availability of medicines at destination; language barriers; access to health services. Effective strategies for travelling with multiple medicines came with experience and knowledge gained from mishaps. Conclusions People who take multiple medicines face challenges adhering to their medication regimen when travelling and devise many useful strategies from which others can learn. Patient’s experiences of travelling with multiple medicines can be informative for the community pharmacist who receives customer requests for advice about travelling with medicines, and from out-of-town customers with medication concerns

A stakeholder visioning exercise to enhance chronic care and the integration of community pharmacy services

© 2018 Elsevier Inc. Background: Collaboration between relevant stakeholders in health service planning enables service contextualization and facilitates its success and integration into practice. Although community pharmacy services (CPSs) aim to improve patients’ health and quality of life, their integration in primary care is far from ideal. Key stakeholders for the development of a CPS intended at preventing cardiovascular disease were identified in a previous stakeholder analysis. Engaging these stakeholders to create a shared vision is the subsequent step to focus planning directions and lay sound foundations for future work. Objectives: This study aims to develop a stakeholder-shared vision of a cardiovascular care model which integrates community pharmacists and to identify initiatives to achieve this vision. Methods: A participatory visioning exercise involving 13 stakeholders across the healthcare system was performed. A facilitated workshop, structured in three parts (i.e., introduction; developing the vision; defining the initiatives towards the vision), was designed. The Chronic Care Model inspired the questions that guided the development of the vision. Workshop transcripts, researchers’ notes and materials produced by participants were analyzed using qualitative content analysis. Results: Stakeholders broadened the objective of the vision to focus on the management of chronic diseases. Their vision yielded 7 principles for advanced chronic care: patient-centered care; multidisciplinary team approach; shared goals; long-term care relationships; evidence-based practice; ease of access to healthcare settings and services by patients; and good communication and coordination. Stakeholders also delineated six environmental factors that can influence their implementation. Twenty-four initiatives to achieve the developed vision were defined. Conclusions: The principles and factors identified as part of the stakeholder shared-vision were combined in a preliminary model for chronic care. This model and initiatives can guide policy makers as well as healthcare planners and researchers to develop and integrate chronic disease services, namely CPSs, in real-world settings

A multilevel stakeholder approach for identifying the determinants of implementation of government-funded community pharmacy services at the primary care level

© 2017 Elsevier Inc. Background: A key early step to enhance the integration of community pharmacy services (CPSs) into primary care practice is identifying key determinants of practice (i.e., critical circumstances that influence the implementation of such services). Involving relevant stakeholders in identifying key determinants enables findings to be more relevant to the context in which CPSs will be implemented. Objective: To identify key determinants of practice that can influence the implementation of government-funded CPSs in a primary health network in Australia. Methods: A stakeholder collaborative approach was used, encompassing two phases. In the first phase, semi-structured interviews were conducted with ground-level stakeholders in Western Sydney between August 2016 to October 2016. Framework analysis was used to code and analyse the data from the interviews into determinants of pharmacy practice. In the second phase, a workshop was conducted with a mixed-group of ground-level and system-level stakeholders from the primary health network to identify key determinants. A four-quadrant prioritization matrix was employed in the workshop to classify determinants based on their importance and feasibility. Results: Sixty-five determinants of practice that can influence CPS implementation were identified in Phase 1. These determinants were allocated at different levels of the healthcare system, and can exist as a barrier or facilitator or both. Twenty-two key determinants were selected in Phase 2, of which three were agreed to be addressed initially: (1) Patient understanding of the aims of the service; (2) Commitment of the organization and its leaders to provide services; (3) Coordination of the healthcare system to prompt collaboration between pharmacists and GPs. Conclusions: This collaborative stakeholder approach identified a set of key determinants of pharmacy practice in this Australian primary care setting. To enhance the implementation of CPSs in this region, initial efforts should be aimed at developing implementation strategies based on these key determinants of practice

Collaborative health service planning: A stakeholder analysis with social network analysis to develop a community pharmacy service.

BACKGROUND:Stakeholder participation optimizes health planning, fostering the acceptability and integration of new health services. Collaborative approaches may help overcome existing challenges in the development, implementation and evaluation of community pharmacy services (CPSs). Stakeholder analyses lay the foundation for building collaboration in the integrated delivery of health care. OBJECTIVES:This stakeholder analysis was performed to organize a collaborative initiative to develop a CPS aimed at preventing cardiovascular diseases in Andalucía (Spain). It aimed to identify stakeholders, differentiate/categorize them, and analyze stakeholder relationships. METHOD:Stakeholders were identified using the snowballing technique. To differentiate/categorize stakeholders and analyze the relationships (i.e., collaboration) an online web-based questionnaire was sent to 186 stakeholders. Stakeholders were asked for: (1) their influence, interest and attitude toward the initiative; (2) stakes/interests; (3) capacity to contribute to the initiative; (4) desire for involvement; (5) concerns; (6) whom they considered a key stakeholder; and (7) the level of collaboration they had with other stakeholders. Data analysis combined descriptive qualitative content analysis, descriptive quantitative analysis and social network analysis. RESULTS:Of the 186 stakeholders approached, 96 (51.6%) participated. The identification process yielded 217 stakeholders (individuals, organizations or collectives), classified into 10 groups. Fifty-seven stakeholders were considered critical to the intended initiative. Most participant stakeholders supported the initiative and were willing to collaborate in the development of the CPS. Public health and science were the main driving interests. A collaboration network existed between the 96 stakeholders. CONCLUSION:This study revealed the magnitude of the social system surrounding the development of a CPS aimed at preventing cardiovascular disease. A large array of stakeholders was identified and analyzed, and a group of critical stakeholders selected. Stakeholder characteristics such as attitude toward the initiative, potential contribution, desire for involvement, and the existing collaboration network, provided complementary information that was helpful for planning the process and stakeholder engagement

RAN remote area nurse

6 episodes of the Australian TV series RAN remote area nurse, set on a remote island where Helen Tremain is the only medico

RAN: Remote area nurse

RAN is a six-part Australian drama series, which tells the story of a white registered nurse, Helen Tremain, working in a health clinic, on Masig Island, in the Torres Strait. The island is home to just under 300 people; and it is one of seventeen island communities governed by individual local councils. The drama begins with Helen's return to the island, after attending her mother's funeral on mainland Australia. Receiving no warm welcome home on arrival at the island's airstrip, Helen sets off to the clinic. She arrives to find everything in chaos, and sets about restoring some kind of order, and in that time viewers meet some of the other principal characters in RAN. As every episode unfolds, the various island characters make an appearance; and, Helen confronts the reality of her doubtful future on the island, whatever strong connections she might have to the place she considers home. The series highlights local issues like domestic violence, dengue fever, diabetes and substance abuse; as well as, lack of employment opportunities for the young, males and females alike. The islanders are portrayed with all their strengths and weaknesses. Describes also the social life and customs of the islanders. Through it all, one glimpses the seemingly idyllic natural beauty and tranquility of the island