Yes / Educational interventions by pharmacists for patients with cancer pain aim to improve pain management, but little is known about the different components of interventions and their effectiveness. Our aim was to assess the benefit of pharmacist delivered educational interventions for patients with cancer pain. A systematic review and meta‐analysis of experimental trials testing pharmacist delivered educational interventions for cancer pain was carried out to identify the components of interventions and effectiveness at improving pain‐related outcomes for patients with cancer. A literature review was conducted in EMBASE, MEDLINE, CINAHL, PsycINFO, ASSIA, Web of Science and CENTRAL from inception until January 2018 searching for educational interventions involving a pharmacist for patients with cancer pain. Four studies were included involving 944 patients. Meta‐analysis was carried out where possible. Meta‐analysis of three of the four studies found that mean pain intensity in the intervention group was reduced by 0.76 on a 0–10 scale (95% confidence interval), although only two of the studies used validated measures of pain. Improvements in knowledge, side effects and patient satisfaction were seen although with less reliable measures. Pharmacist educational interventions for patients with cancer pain have been found to show promise in reducing pain intensity. Studies were few and of varying quality. Further, good quality studies should be carried out in this area and these should be comprehensively reported. Trials measuring patient self‐efficacy and patient satisfaction are needed before the impact of the pharmacist delivered interventions on these outcomes can be established.

Medicines optimisation requires healthcare professionals to work collaboratively to meet the medication needs of patients. A grounded theory was produced which explains how doctors, nurses and pharmacists work to optimise the use of medicines in acute hospital settings in Northern Ireland. Seventeen semi-structured, one-to-one interviews were conducted with doctors, nurses and pharmacists. Concurrent data collection and analysis was carried out using coding, particular to grounded theory, adopting a constant comparative approach, writing memos and using theoretical sampling as described by Strauss and Corbin (1998). The core category was managing risk. Participants had an implicit understanding of the need to continually manage risk when working with the complex and the routine. They used personal and systemic checks and balances which could be viewed either as duplication of effort or indicative of a culture of safety. Multi-professional interdependencies and support for new, professional, non-medical roles were highlighted. Working together was a further strategy to ensuring each patient gets the right medicine. Establishing an agreed framework for working with medicines at ward level could support the safer use of medicines. It is anticipated that this theory will contribute to the design of systems involved in medicines use in acute hospitals in Northern Ireland. / Part-funded by: Northern Ireland Centre for Pharmacy Postgraduate Learning and Development (NICPLD), Western Health and Social Care Trust

Background: At the end of life, patients living in their own homes experience significantly more pain than those who die in either hospital or hospice care (Office for National Statistics, 2015). With an increasing prevalence of this, person-centred medicines optimisation is essential. Aim: To investigate the feasibility of community pharmacist medicines optimisation services for patients living with advanced cancer pain in community settings. Methods: Mixed methods were used, adopting a pragmatic stance and approach. Qualitative interviews, a systematic review and meta-analysis and a proof-of-concept study were undertaken. Results: Patients with advanced cancer pain need support with their medicines which could be provided by a pharmacist. Patients experienced a significant number of medicines related problems, even those already receiving specialist palliative care. Most problems were addressed by pharmacist advice with the remainder being referred for additional prescribing. Care for patients with cancer pain is currently not person-centred and the current medicines optimisation model is unsuitable for this patient group. An enhanced model of medicines optimisation is therefore presented for patients with advanced cancer and this model can be amended and adopted for other patient groups. Conclusions: An enhanced medicines optimisation model (MOCAP) has been created to inform person-centred medicines optimisation for patients with advanced cancer pain. Feasibility and acceptability were also confirmed and it can be adapted for further clinical use. This model contributes to the goals of the NHS agenda of choice and control of care as proposed in the NHS Long Term Plan (NHS, 2019b).

Yes / Medicines management is only one part of NHS (UK) procurement and management, but essentially a very expensive part. According to the Commercial Medicines Unit (Department of Health, 2013), NHS hospitals in England currently spend around £3.6 billion annually on pharmaceuticals, having risen from £2.2. billion in 2005. The NHS continuously strives to promote excellence in what it does and justify how it does it. In undertaking this preliminary analysis 45 pharmacy staff members contributed to an online survey. The results presented a broad mix of views on how smart technology (e.g. iPhone, iPad) could be used and if it should be used at all in this setting. The outcome of this small scale study demonstrates the lack of knowledge as to if and how such technologies could be used in hospital pharmacy and therefore present grounds for testing out the broader application of smart technology via academic and practitioner consultations.

Yes / Background Patients with advanced cancer commonly experience pain and it is least controlled in community settings. Community pharmacists in the UK already offer medicines optimisation consultations although not for this patient group. Objective To determine whether medicines consultations for patients with advanced cancer pain are feasible and acceptable. Setting Community-dwelling patients with advanced cancer pain were recruited from primary, secondary and tertiary care using purposive sampling in one UK city. Methods One face-to-face or two telephone delivered medicines optimisation consultations by pharmacists were tested. These were based on services currently delivered in UK community pharmacies. Feedback was obtained from patients and healthcare professionals involved to assess feasibility and acceptability. Main outcome measure Recruitment, acceptability and drug related problems. Results Twenty-three patients, (range 33–88 years) were recruited, 19 completed consultation(s) of whom 17 were receiving palliative care services. Five received face-to-face consultations and 14 by telephone during which 47 drug related problems were identified from 33 consultations (mean 2.5). Advice was provided for 34 drug related problems in 17 patients and referral to other healthcare professionals for 13 in 8 patients, 2 patients had none. Eleven patients returned questionnaires of which 8 (73%) would recommend the consultations to others. Conclusion The consultations were feasible as patients were recruited, retained, consultations delivered, and data collected. Patients found the 20–30 min intervention acceptable, found a self-perceived increase in medicines knowledge and most would recommend it to others. Community pharmacists were willing to carry out these services however they had confidence issues in accessing working knowledge. Most drug related problems were resolved by the pharmacists and even among patients receiving palliative care services there were still issues concerning analgesic management. Pharmacist-conducted medicines consultations demonstrate potential which now needs to be evaluated within a larger study in the future. / Funded as part of the Improving the Management of Pain from Advanced Cancer in the CommuniTy (IMPACCT) study which was a National Institute of Health Research programme Grant of which this was part of the Medicines work stream (RP-PG-0610-10114).

Yes / Objective Medication arrangements for patients with severe mental illness (SMI), including schizophrenia and bipolar disorder, can be complex. Some have shared care between primary and secondary services while others have little specialist input. This study investigated the contribution a specialist mental health clinical pharmacy team could make to medicines optimisation for patients on the SMI register in primary care. Research shows that specialist mental health pharmacists improve care in inpatient settings. However, little is known about their potential impact in primary care. Method Five general practice surgeries were allocated half a day per week of a specialist pharmacist and technician for 12 months. The technician reviewed primary and secondary care records for discrepancies. Records were audited for high-dose or multiple antipsychotics, physical health monitoring and adherence. Issues were referred to the pharmacist for review. Surgery staff were encouraged to refer psychotropic medication queries to the team. Interventions were recorded and graded. Results 316/472 patients on the SMI register were prescribed antipsychotics or mood stabilisers. 23 (7%) records were updated with missing clozapine and depot information. Interventions by the pharmacist included clarifying discharge information (12/104), reviewing high-dose and multiple antipsychotic prescribing (18/104), correcting errors (10/104), investigating adherence issues (16/104), following up missing health checks (22/104) and answering queries from surgery staff (23/104). Five out of six interventions possibly preventing hospital admission were for referral of non-adherent patients. Conclusion The pharmacy team found a variety of issues including incomplete medicines reconciliation, adherence issues, poor communication, drug errors and the need for specialist advice. The expertise of the team enabled timely resolution of issues and bridges were built between primary and secondary care.