[Abstract] How to secure better outcomes for everybody in asthma management: the international-medicines use review health technology assessment (international-MUR HTA)

Aims: This project is looking at the development and application of the novel tool (International–Medicines-Use-Review-Health-Technology-Assessment; International-MUR HTA) in community practice that for the first time is able to meet better asthma control and secure added value service in asthma management. More specifically it allows to: evaluate the quality of care delivered in terms of economic impact (for patient-provider-society), health outcomes and patient benefits; collect real-world evidence and evaluate longterm effect of care; provide different stakeholders with evidence-based information that would help formulate health policies in community practice that are safe, effective, patient-focused and cost-effective, balancing access to innovation and cost containment. Crucially, the tool can also support the delivery of a cost-effective and cost-saving intervention for asthma patients based on the success of the Italian-Medicines-Use-Review (I-MUR) trial [1]. Methods: Evidence from the Italian-Medicine-Use-Review (I-MUR) trial showed that the I-MUR intervention provided by the community pharmacists in asthma is effective, cost-saving and cost-effective.1 The trial allowed to model a novel framework (International-MUR-HTA) that would enable to routinely deliver the intervention, but also collect and analyse patient relevant data on its clinical-effectiveness, quality-of-life and cost-effectiveness. I-MUR-HTA was discussed within three expert-panel discussions including policy-makers, commissioners, academics, healthcare-professionals and patientrepresentatives in Italy,2 UK3 and Brussels/Europe.4 The current plan includes testing the use of the tool in RW environment across European regions. Results: Evidence collected from the expert discussions confirmed that International-MUR-HTA information is relevant to meet current NICE target for cost-effective service delivery and this is what is needed to support the evaluation of innovative effective and cost-effective health policies and promote their implementation across nations. Its implementation is underway and real-world pilots are planned to take place in different European regions. Conclusion: the International-MUR-HTA appears to be an innovative tool to promote active patient involvement into policy-decision-making and community service implementation

Pharmacists’ and patients’ views and feedback on Italian Medicines Use Review (I-MUR)

Rationale, aims and objectives: Although medicine review services are offered by community pharmacists in many countries, they are non-existent in Italy. A novel intervention I-MUR, was developed for patients with asthma aiming to improve medicines use. The aim of this study was to obtain pharmacists’ and patients’ views on the acceptability of the I-MUR service provided by community pharmacists to asthma patients in four regions of Italy. Methods: Pharmacists’ expectations, experiences and attitudes to delivering the I-MUR were obtained through questionnaires distributed before and after delivering the I-MUR, plus focus groups. Patients’ views were obtained via questionnaires, distributed by the pharmacists and returned anonymously. Results: Seventy-four pharmacists provided the I-MUR service to 895 asthma patients; 49 pharmacists completed both questionnaires, 53 participated in focus groups and 246 patients returned questionnaires. Barriers anticipated most frequently by pharmacists before the I-MUR were lack of time (53%) and lack of co-ordination with other health professionals (61%), while lack of financial compensation was identified by 37%. Lack of co-ordination proved the most common actual barrier (88%), with lack of financial compensation being cited less frequently after providing the intervention (8%). Ninety-six percent of pharmacists anticipated providing both education on inhaler technique and medication counselling, but in practice slightly fewer had provided these (90% and 86% respectively). Focus groups highlighted a lack of relevant undergraduate education to support medication review and structural barriers within some pharmacies, but described positive patient feedback and desire to extend the I-MUR. Patients’ respondents were positive; 62% indicated the reason for having an I-MUR as making sure that they were using medication correctly, 75% considered they benefited from it and 86% would recommend it to others. Conclusions: The I-MUR service was perceived positively by both pharmacists and patients, supporting the extension of medicine review services to community pharmacists in Italy

Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider

Introduction: A key priority in asthma management is achieving control. The Asthma Control Test (ACT) is a validated tool showing a numerical indicator which has the potential to provide a target to drive management. A novel pharmacist-led intervention recently evaluated and introduced in the Italian setting with a cluster randomised controlled trial (C-RCT) showed effectiveness and cost-effectiveness. This paper evaluates whether the intervention is successful in securing the minimally important difference (MID) in the ACT score and provides better health outcomes and economic savings. Methods: Clinical data were sourced from 816 adult patients with asthma participating in the C-RCT. The success of the intervention was measured looking at the proportion of patients reaching MID in the ACT score. Different levels of asthma control were grouped according to international guidelines and graded using the traffic light rating system. Asthma control levels were linked to economic (National Health Service (NHS) costs) and quality-adjusted life years outcomes using published data. Results: The median ACT score was 19 (partially controlled) at baseline, and 20 and 21 (controlled) at 3-month and 6-month-follow up, respectively (p<0.01). The percentage of patients reaching MID at 3 and 6 months was 15.8% (129) and 19.9% (162), respectively. The overall annual NHS cost savings per 1000 patients attached to the shift towards the MID target were equal to €346 012 at 3 months and increased to €425 483 at 6 months. Health utility gains were equal to 35.42 and 45.12 years in full health gained, respectively. Discussion: The pharmacist-led intervention secured the MID in the ACT score and provided better outcomes for both patients and providers

Students and faculty perception of Active Learning: a case study

Active Learning (AL), a pedagogical approach during which students focus on application of knowledge rather than memorisation was integrated into a new undergraduate pharmacy curriculum in a UK University. This paper evaluates student and faculty perceptions of AL. First and second year students enrolled on the pharmacy course and faculty members were invited to respond to an online questionnaire covering three domains: value, effort and instructor contribution during AL sessions. Thirty-five students (58.3%) and 9 (60%) faculty members participated in the study. Nine AL sessions were provided. A difference in the perceived effectiveness of AL between students and faculty was identified mostly in two AL activities: patient as teacher (an expert patient talking about his/her condition to pharmacy students) and prescription review. Students and faculty confirmed the value of the AL activities with agreeing and strongly agree. Students confirmed they put effort into these activities and recognised the instructor contribution during the sessions. Overall, students and faculty had a positive perception of the AL sessions

Optimal scaling and contingency tables reveal the mismatch between patients’ attitude and perception towards their asthma medications and complaints during the I-MUR service provision

Asthma prevalence is increasing and the economic loss due to lack of asthma control is €72 billion in EU 28. Pharmacists have a role to play, and a bespoke novel pharmacist-led intervention for asthma patients, called Italian Medicines Use Review (I-MUR), has shown both effectiveness and cost-effectiveness. The I-MUR intervention enables asthma patients to optimise the effect of their medications. This study aimed at assessing the mismatch between patients’ attitude-perception towards their medications and their complaints during the I-MUR service provision. The I-MUR was provided in four different Italian locations; data were collected and analysed using descriptive statistics, optimal scaling and contingency tables. The number of pharmacists and asthma patients involved in the study was 74 and 895 respectively. The majority of patients (72%) did not believe that they had problems with their medications, 78% confirmed that they had full knowledge and understanding of their medications, 75% said that their medications were working and 45% confirmed that they missed a dose. The number of patients who raised complaints was 683 (76%) and the number of complaints raised by each patient ranged between 1 to 5. Only 18% of the patient population reporter having neither medicine-related problems nor asthma-related complaints. The use of optimal scaling and contingency tables unveiled the mismatch between patients’ attitude-perception towards their medicines and the type and number of complaints raised by them during the I-MUR service provision

VP164 Applying health technology assessment to pharmacy: the Italian-Medicine-Use-Review-Health Technology Assessment

There is a lack of Health-Technology-Assessment (HTA) tools in pharmacy practice and the collection of real-world-evidence (RWE) in community pharmacy to populate longer-term-disease-progression-modelling (1). This project is looking at the development and application of a novel Patient-Reported-Outcome- Measure (PROM) in community pharmacy that can enable: the evaluation of the quality of care delivered from the patient perspective in terms of economic impact, patient health outcomes and ‘utilities’; the collection of RWE and evaluate long-term effect of care; to provide different stakeholders with unique evidence-based information that help formulate health policies in community pharmacy that are safe, effective, patient-focused and cost-effective, balancing access to innovation and cost containment. Evidence from the Italian-Medicine-Use-Review (I-MUR) trial (2) showed that the I-MUR intervention provided by community pharmacists to asthma patients is effective, cost-saving and cost-effective (3). The trial allowed to model a framework (I-MUR-HTA) that would enable to routinely deliver the intervention, but also collect and analyse PROM data on its clinical-effectiveness, quality-of-life and cost-effectiveness. I-MUR-HTA was discussed within three expert-panel discussions including policy-makers, commissioners, academics, healthcare-professionals and patient-representatives in Italy, United Kingdom and Europe. Current plan include testing the use of the tool in the real world environment. Evidence collected from the panel discussions confirmed that I-MUR-HTA evidence-based information is relevant to meet current National-Health-Care-System plans and this is what is needed to support the evaluation of innovative effective and cost-effective health policies and promote their implementation across nations. Current Italian law on pharmacy services provides the appropriate institutional framework to regulate the introduction of I-MUR-HTA across the territory. Its implementation is underway and a real-world pilot is planned to take place in Italy. I-MUR-HTA appears to be an innovative tool to promote active patient involvement into policy-decision-making and pharmacy-service

Patient as teacher sessions contextualize learning, enhancing knowledge, communication, and participation of pharmacy students in the United Kingdom

Purpose: This study aimed to evaluate the impact of Patient As Teacher (PAT) sessions on the knowledge, communication skills, and participation of pharmacy students in the United Kingdom. Methods: During the academic year 2019-2020, year 1 and 2 pharmacy students at the University of Central Lancashire were invited to complete a questionnaire following PAT sessions. Data were analyzed by means of descriptive statistics, including mean and standard deviation (SD) for: continuous variables and reliability analysis. Pearson’s Chi-Square or Fisher Exact Test, odds ratio, and Phi were used for analyzing dichotomous variables. Thematic analysis was used for free text comments. Results: Sixty eight of 228 students participated, (response rate of 29.8%). No statistical difference was found between gender (p=0.090); a statistically significant difference was found between year (p=0.008). Cronbach's alpha (0.809) confirmed a good internal consistency. 97.0% of the students learned a lot, and 85.3% appreciated and valued the PAT sessions; 89.7% wanted more sessions. 92.7% perceived the sessions to contextualize their learning. Five questions were dichotomized by grouping the responses into negative and positive; 90.3% of responses were positive and did not show statistically significant differences in gender and year of study. Overall students’ free text comments were positive, but active listening and consultation appeared in the positive and negative domains, highlighting the need for more student engagement. Conclusions: PAT sessions had a positive impact on students’ knowledge, communication skills, and participation, and contextualized learning. They provide a valuable contribution to the pharmcy students’ experience in the United Kingdom

Impact of reduced idea density on pharmacy students’ attainment in pharmaceutical calculations: A study protocol for a single-blind multicentre randomised controlled trial

Introduction: To register as a pharmacist in the United Kingdom, an exam set by the General Pharmaceutical Council must be undertaken. It involves pharmaceutical calculations and shows variable pass rates. Linguistic factors, such as idea density, affect and predict comprehension time. This trial will evaluate the effect of lowering question idea density on attainment in a pharmaceutical calculations exam aligned to that of the General Pharmaceutical Council Methods: This is a single-blind, parallel 2-arm multicentre randomised controlled trial conducted in 14 Universities across the United Kingdom. A 1:1 randomisation and a sample size of 198 pharmacy students will be sufficient to detect a 1-point difference in the mean scores between the intervention and control group during a pharmacy calculation test with two-tails, 80% power and 5% significance level. Each school will recruit a minimum of 14/15 students. Participants will sit two 12-question pharmaceutical calculation tests. All students will take the same baseline test; then, will be randomised and undertake a second test 2-week after, with standard idea density for the control group and lower idea density for the intervention. Primary outcome: the scores obtained by the students undertaking the second calculation test 2-week after the baseline. Sec�ondary outcomes: percentage of students achieving a pass during the second test; effect of demographic characteristics (first or not-first English language speakers, age, ethnicity, year of study, specific learning disability) on students’ attainment when lowering idea density Conclusion: Results could inform the development of new standards in pharmaceutical calcula�tions exams. Trial registration number: NCT05526365 (registered 31/08/2022

Reporting and interpreting the numerical results of a vaccine trial: a practical guide for students and health care professionals

In one year, the COVID pandemic has changed the world. Universities, pharmaceutical companies, and many other organisations worldwide worked effortlessly to develop vaccines to ease the socioeconomic burden of the disease and improve global health care. Nowadays, vaccine efficacy is a very popular term; but do we know what it means and how to calculate it? This article provides information on reporting and interpreting the numerical results of a vaccine trial. It aims to be a practical guide for students and health care professionals. It gives a simple definition of the common terminology, the vaccine efficacy, how to calculate it, and how the confidence interval can be found (though formulae for the latter are not given here). Additionally, it provides two simple examples (A, B), including the formulae for calculating the vaccine efficacy explaining the differences of vaccine efficacy between the two examples simply and pragmatically