Gulzar, Nargis

Latif, Asam

Mandane, Baguiasri

English

De Montfort University Open Research Archive

The Pharmaceutical Journal 26 NOV2019Developing a co-produced e-learning programme to supportmarginalised medically underserved patientspharmaceutical-journal.com/news-and-analysis/opinion/correspondence/developing-a-co-produced-e-learning-programme-to-support-marginalised-medically-underserved-patients/20207364.articleThere have been recent calls for the NHS to pursue a value-based healthcare system, onethat is “equitable, sustainable and transparent” . However, promoting a culture basedon the values of patient-centred care can be challenging. One notable example inpharmacy was the concern that medicines use reviews (MURs) were being driven byorganisational targets in preference to patient need . Consequently, in 2019, it wasannounced that MURs would be phased out and replaced by structured medicationreviews, which will be carried out by pharmacists working within primary carenetworks .Vulnerable people belonging to marginalised groups (e.g. those with disabilities, who arehomeless, or from the black, Asian and minority ethnic [BAME] community) oftenexperience inequitable access to healthcare, poorer patient–professional communicationand sometimes racism or cultural bias . They may hold strong beliefs that theycannot be helped, face discrimination or disempowerment because of theircircumstance and are often disenfranchised from mainstream primary healthcareservices . Inequitable access to routine and preventative care increases demandon acute services, contributes to emergency admissions and adds further pressure to analready stretched healthcare system .Recent research has indicated that marginalised or medically “underserved” patients arenot accessing or being offered medicine support services, including MURs . To redressthe balance and to raise awareness of this group of patients, an e-learning resource forpharmacy staff was developed using a co-production approach. Co-production is a modelthat actively involves service users, carers and communities in equal partnership throughacknowledging patients’ “lived experience”. They are best placed to advise on the supportand services that will make a positive difference to them .In total, 57 participants (33 patients and 24 pharmacy professionals) attended one offour half-day co-production workshops in Nottingham during autumn and winter 2016.Patient representation was from a range of marginalised groups, including the asylumand refugee community; the BAME community; those with disabilities; those who werehomeless; those who were housebound; the lesbian, gay, bisexual and transgender andqueer community; those diagnosed with mental illness; people from the Gypsy, Romaand Traveller communities; and older people with multiple morbidity and medicines.Pharmacy representation was from community pharmacy staff (i.e. pharmacists,accredited technicians, dispensers, medicine counter assistants); superintendentpharmacists; community pharmacy owners; and pharmacy representatives, professionalleadership and educational bodies (i.e. local pharmaceutical committees, the RoyalPharmaceutical Society, the Centre for Pharmacy Postgraduate Education).To ensure the widest possible patient participation and representation, tried and tested[1][2][3][4],[5][6],[7],[8][9][10][11]1/5To ensure the widest possible patient participation and representation, tried and testedengagement strategies were deployed . These included using extended recruitmentand engagement time frames, planning for higher resourcing costs and operating viacommunity partnership. A £200 inconvenience allowance was made available to allworkshop participants, whether they were patients or pharmacy staff. To support andfurther the findings from the workshops, ten one-to-one interviews were also conductedwith patients from marginalised groups.At these workshops, discussions centred around medicines issues and the challengesfaced when using pharmacies and the wider healthcare system. The contents of the e-learning programme were incrementally built and refined over the four workshops.Personal written reports, along with group suggestions to improve the MUR service,were captured on storyboards to elicit a more detailed plan for the contents of thelearning. The final specification was then passed on to the Health e-Learning and Mediateam at the University of Nottingham, which used this information to create the digitalresource.Broadly, the findings supported previous literature that many patients experiencedsignificant problems with access to healthcare, problems with medicines (i.e. non-adherence), and that their status or circumstances often left them feeling sociallyisolated. When asked about their experiences of pharmacy, opinions were mixed, withsome patients expressing gratitude when they found this to be a friendly and usefulencounter. However, others perceived pharmacies as busy places and this limited thescope for patients to see them as a places to access or resolve health or medicine-related issues.The final co-produced resource consists of the following three components:1. Discovering and understanding under-served communities;2. Exploring the medicine experiences and needs of patients who are under-served;3. Effectively interacting and engaging patients who are under-served.The co-produced digital educational resource can be freely accessed and shared with thepharmacy team through this link.Since the development of the co-produced e-learning resource, its impact andeffectiveness have been tested in a before and after comparison evaluation study .The resource was effective at engaging with and improving the perceived capabilities ofpharmacy professionals towards groups that are medically under-served, however, thefindings also indicated that organisational barriers may hinder the translation of learninginto effective behaviour change .Improving fairness, social justice and addressing inequitable access to health servicesfeatures as a priority for the NHS . Employing the co-production approach has thepotential to transform the delivery of pharmacy services, reduce healthcare inequity andpromote value-based healthcare. Our work shows that this process can guidereconfiguration of a service and lead to care being provided to those most in need.Asam Latif, senior research fellow, University of NottinghamBaguiasri Mandane, pharmacist, Guy’s and St Thomas’ NHS TrustNargis Gulzar, senior lecturer, Leicester School of Pharmacy, De Montfort UniversityCitation: The Pharmaceutical Journal, online, online | DOI: 10.1211/PJ.2019.20207364Recommended from Pharmaceutical PressPrevious[12][13][14][15]2/5PreviousNextDrugs and the LiverDrugs and the Liver assists practitioners in making pragmatic choices for theirpatients. It enables you to assess liver function and covers the principles of druguse in liver disease.£38.00Buy now3/5Hospital Pre-registration Pharmacist TrainingA practical explanation for undergraduates and pre-registration trainees. Showswhat to expect from a hospital pre-registration pharmacist training programme.£25.00Buy nowGood Pharmacovigilance Practice GuideAn essential guide on pharmacovigilance of medicinal products for human use.Practical advice for developing effective pharmacovigilance systems.£38.00Buy now4/5Developing Your Prescribing SkillsDeveloping Your Prescribing Skills uses case studies, mind maps and feedbackfrom experienced prescribers. It supplies practical advice on the issues facingprescribers in all types of practice.£23.00Buy nowSearch an extensive range of the world’s most trustedresourcesPowered by MedicinesComplete5/5

Developing a co-produced e-learning programme to support marginalised medically underserved patients

https://dora.dmu.ac.uk/bitstream/2086/18954/1/pharmaceutical-journal.com-Developing%20a%20co-produced%20e-learning%20programme%20to%20support%20marginalised%20medically%20underserved%20patients.pdf

Developing a co-produced e-learning programme to support marginalised medically underserved patients

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