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Yes / A new programme incorporating online study days delivered using team-based learning (TBL) for hospital-based trainee pharmacists (TPs) in the North of England was created. To our knowledge, TBL has not previously been used in educational programmes for TPs designed to supplement their workplace learning. The project aimed to investigate the experiences of TPs learning using online TBL by exploring their perceptions on their engagement, learning, and satisfaction with TBL. Data were collected using online anonymous surveys at the end of four online TBL study days. A bespoke survey consisted of 5-point or 4-point Likert scale and two free text questions. TBL Student Assessment Instrument (SAI), a validated survey, was used to assess TPs' acceptance of TBL. Survey data was summarized descriptively, and free text comments analysed using thematic analysis. TPs developed accountability to their team, remained engaged with TBL delivery online and stated a preference for and satisfaction with this method. TPs valued opportunities to apply their knowledge in challenging scenarios and learn from discussions with their peers, the larger group, and facilitators. TBL was also perceived to be an engaging approach to learning and helped to maintain their interest with the teaching material. However, TPs struggled to engage with pre-work outside of the class due to competing work priorities. This study shows that online TBL was well accepted by TPs and can be successfully used to deliver education to large cohorts of learners. The model developed shows potential for scalability to larger numbers of learners. / The teaching programme was funded by National Health Service England Workforce, Training, Education (NHSE WTE) (previously known as Health Education England).

No / Many studies have highlighted the problems associated with different aspects of medicines reconciliation (MR). These have been followed by numerous recommendations of good practice shown in published studies to decrease error; however, there is little to suggest that practice has significantly changed. The study reported here was conducted to review local medicines reconciliation practice and compare it to data within previously published evidence. To determine current medicines reconciliation practice in four acute hospitals (A–D) in one region of the United Kingdom and compare it to published best practices. Quantitative data on key indicators were collected prospectively from medical wards in the four hospitals using a proforma compiled from existing literature and previous, validated audits. Data were collected on: i) time between admission and MR being undertaken; ii) time to conduct MR; iii) number and type of sources used to ascertain current medication; and iv) number, type and potential severity of unintended discrepancies. The potential severity of the discrepancies was retrospectively dually rated in 10% of the sample using a professional panel. Of the 250 charts reviewed (54 Hospital A, 61 Hospital B, 69 Hospital C, 66 Hospital D), 37.6% (92/245) of patients experienced at least one discrepancy on their drug chart, with the majority of these being omissions (237/413, 57.1%). A total of 413 discrepancies were discovered, an overall mean of 1.69 (413/245) discrepancies per patient. The number of sources used to reconcile medicines varied with 36.8% (91/247) only using one source of information and the patient being used as a source in less than half of all medicines reconciliations (45.7%, 113/247). In three out of the four hospitals the discrepancies were most frequently categorized as potentially requiring increased monitoring or intervention. This study shows higher rates of unintended discrepancies per patient than those in previous studies, with omission being the most frequently occurring type of discrepancy. None of the four centers adhered to current UK guidance on medicines reconciliation. All four centers demonstrated a strong reliance on General Practitioner (GP)-based sources. A minority of discrepancies had the potential to cause injury to patients and to increase utilization of health care resources. There is a need to review current practice and procedures at transitions in care to improve the accuracy of medication history-taking at admission by doctors and to encourage pharmacy staff to use an increased number of sources to validate the medication history. Although early research indicates that safety can be improved through patient involvement, this study found that patients were not involved in the majority of reconciliation encounters.

The full text will be available at the end of the embargo period: 5th Nov 2021

The aim of this research was to investigate the structures and processes of pharmacist prescribing in Great Britain, focusing on primary care settings. A ‘sequential-mixed methods’ was employed in the conduct of the research. The first phase was a cross-sectional postal questionnaire of all pharmacist prescribers (n= 1654 in January 2009), to quantify the extent and nature of prescribing and key factors associated with prescribing practice. Response rate was 42.3% (n=695). The pharmacy practice setting was significantly associated with prescribing (those in hospital or general medical practice were more likely to have prescribed (p< 0.05), than respondents in community practice). Factor analysis of attitudinal statements on prescribing implementation revealed factors, grouped as: ‘administrative structures and processes’, ‘perceptions of pharmacists’ prescribing role’ and ‘facilities for prescribing’. Scores for ‘facilities for prescribing’ varied depending on practice setting. Respondents in community practice recorded lower median scores compared with those in general medical practices. However, there were no statistically significant differences in median scores between respondents based in GP and hospital settings. In-depth qualitative work undertaken in the second phase further explored facilitators of, and challenges to prescribing practice (e.g. the lack of defined prescribing roles) identified in phase one. Semi-structured interviews were conducted with a purposive sample of 34 prescribers. Prescribers were selected from diverse settings, including secondary care from England and Scotland, to highlight key factors contributing to prescribing success which could potentially inform extrapolations of successful practice from one setting to the other. The ‘framework’ approach to qualitative data analysis was rigorously applied, revealing that the professional isolation and issues around access to clinical data and administrative support in the community setting may have negatively impacted on prescribing implementation. Notably, a perceived lack of clarity and definition of the pharmacist prescribing role was a key theme in hindering prescribing practice of pharmacists irrespective of setting. Participants described ‘ideal’ roles which they perceived as potentially providing clarity, definition and direction to facilitate implementation. The original data generated through this research highlights that prescribing implementation is less than desired, especially in community pharmacies. Pharmacist prescribing appears to have progressed little since supplementary prescribing developments in 2004, even with the much heralded arrival of independent prescribing in 2006. Interestingly, phase 2 participants suggested a ‘hybrid supplementary/independent’ prescribing model, as more likely to succeed. In this model, pharmacist prescribers favour a cooperative practice arrangement in which doctors diagnose and pharmacists prescribe. The implication of these findings and specific recommendations for policy makers, other key stakeholders and practitioners are discussed in detail within the thesis.

The impact of the pharmacist in elderly patient healthcare management is developing. In our study, the interventions made by community pharmacists in the RESPECT study (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) were analysed and evaluated. In our study, the study sample was chosen according to specific criteria. The outcomes of these pharmacist interventions were measured by a clinical panel which scored and categorised each intervention into one of five categories. The study also investigated the percentage of interventions implemented or not implemented by GPs. In our study, initially 398 patients and of these 52 were excluded because their files did not contain the entry criteria information, leaving 346 patients who were identified with a mean (SD) of 8.9 (3.3) pharmaceutical care plans which contained mean (SD) 8.2(7.2) pharmaceutical care issues. Of these 43% were males and 57% were females with a mean (SD) age of 81(3.7) years. There were many missing data about drugs prescribed due to poor documentation by community pharmacists in the RESPECT study particularly at post study period (T5). The mean (SD) for all drugs prescribed was 35.9 (12.38) for each patient and for the whole study period including the post period (T5). In our study a total of 2879 individual pharmaceutical care issues were identified. A clinical panel judged that 43% of the interventions prevented harm, 31% improved the efficacy of management, 3% were detrimental to the patient's management plan, 12% only provided information and there was insufficient information to make a decision on the remaining 11%. For the classifications prevented harm to the patient and improve efficacy of management, the panel gave a score of 7 or more to 264 and 103 respectively which were classed as potential prevented hospital admissions. The outcome of 1628 could not be determined from the data and the pharmacist did not intervene on 361 occasions. Of the remaining 890 (30.9%) GPs accepted 715 and did not accept 175. The cost effectiveness of providing pharmaceutical care to older people by community pharmacists could be estimated (£620,000) by calculating reduction in expenditure of hospital admissions. In addition, there would be the possibility of reduced pressure on other NHS resources such as availability of hospital beds. The involvement of a clinical pharmacist in elderly patient health care, within the setting of a community pharmacy, provided positive healthcare outcomes and therefore should be encouraged in line with the new white paper for England "Building on strengths-delivering the future" (2008). The study emphasises the importance of revising the nature and period of postgraduate training for community pharmacists who are going to provide pharmaceutical care for elderly patients. This raises the possibility of specialised competency based postgraduate training for community pharmacists with a special interest in the care of older people (PhwSI). This would enable community pharmacists practising as generalists to become advanced practitioners in the specialist clinical area of older people and ensure a consistent level of service for elderly patients in line with government expectations.

Diabetes mellitus is a group of metabolic disorders caused by a relative or absolute lack of insulin. Currently, 23.6 million Americans have diabetes. Diabetes can lead to serious microvascular and macrovascular complications, such as cardiovascular disease, blindness, kidney disease, lower-limb amputations, and premature death. Due to the potential cardiovascular complications and the high prevalence of co-morbid hypertension and/or hyperlipidemia in patients with diabetes, diabetes management should include close monitoring of blood glucose, blood pressure, and cholesterol levels. Medical management of diabetic patients is costly; approximately 1 in every 10 health care dollars is currently spent treating diabetes. Studies have shown that in chronic conditions such as diabetes, increased medication use results in demonstrable improvements in health outcomes, reduced hospitalization rates, and decreased direct health care costs. To date no studies have evaluated the impact of a pharmacist-led intervention on diabetic medication adherence. The purpose of this investigation was to analyze the impact of a pharmacist-led medication management program on medication adherence and pharmacy costs and to evaluate clinical measures of diabetes, hypertension, and hyperlipidemia. This study was a quasi-experimental, longitudinal, pre-post study, with a control group. Scott & White Health Plan (SWHP) patients with diabetes (type 1 or type 2), poor glycemic control (most recent A1C >7.5%), and living within 30 miles of participating pharmacies were invited to participate in the intervention which consisted of monthly appointments with a clinical pharmacist and a co-payment waiver for all diabetes medications and testing supplies. A total of 118 patients met study inclusion criteria and were enrolled in the intervention between August 2006 and July 2008. Intervention patients were matched on sex and age to SWHP patients with poor diabetes control living more than 30 miles from a participating pharmacy. To measure the impact of the intervention, medical and pharmacy data were evaluated for one year before and after the study enrollment date. A significant difference was seen in the percentage of patients with type 1 diabetes in the intervention group (14) and the control group (3). The medication management program significantly improved A1C levels in intervention patients relative to controls (-1.1% vs. 0.6%) and was more effective in lowering A1Cs in type 2 diabetics than type 1 patients. Although the generalized linear model did not show that the intervention significantly improved the percentage of patients achieving the ADA goal A1C of <7% compared to controls, the multivariate logistic regression, which controlled for factors such as diabetes type, showed that patients participating in the intervention were 8.7 times more likely to achieve the A1C goal. Persistence with diabetic medications and the number of medications taken significantly increased in the intervention group; however, adherence rates, as measured by medication possession ratio (MPR), did not significantly improve relative to controls. The expenditure on diabetic medications and testing supplies increased substantially more in the intervention group than in the control group. The percentage of patients adherent with antihypertensive medications (MPR ≥80%) increased from 76% to 91% in the intervention group and decreased from 68% to 63% in the control group (P<0.05); no significant difference in blood pressure control was observed. For hyperlipidemia medications, adherence and persistence increased and pharmacy costs decreased in both groups, likely due to the introduction of the first generic HMG-CoA reductase inhibitor into the market during the study period. Future research is needed on the impact of the intervention on medical resource utilization and costs. / text

Class of 2017 Abstract / Objectives: To determine if the use of RxSkills effectively improves student scores on the North American Pharmacist Licensure Examination (NAPLEX)-based questions among third and fourth-year pharmacy students at the University of Arizona (UA) College of Pharmacy. Methods: This is a pre-post interventional study using a survey of volunteer students from the classes of 2016 and 2017 at the UA College of Pharmacy. An email calling for volunteers was sent using the listserv to students providing information regarding the study. Once the pre-test was completed, instructions for downloading the mobile application were sent to the students. After six weeks of RxSkills use, a link to the post-test was sent to the students for completion. Student scores on the NAPLEX-based questions, use of the application (frequency and duration) and helpfulness, and demographic data were collected. Results: The number of participants in the study from each class was similar with 15 students from the Class of 2016 (52%) and 14 from the Class of 2017 (48%). There was no correlation between how often RxSkills was used and improvement in scores. Overall, student score on the NAPLEX-based questions were significantly improved post-RxSkills use (mean 10.48, SD 2.49) compared to pre-RxSkills use (mean 9.68, SD 2.24) with a p-value of 0.03. Conclusions: The use of RxSkills resulted in an improvement in student scores on the NAPLEX-based questions, indicating its usefulness in studying for the NAPLEX. Students would benefit from using the application when studying for this exam.

ABSTRACT Successful communication with patients in a multicultural, multilinguistic environment is a challenge to health professionals, particularly in the context of HIV/Aids and antiretroviral (ARV) treatment. Although the introduction of ARVs has brought hope, high levels of adherence are required to ensure treatment success and numerous barriers to adherence exist. Pharmacists play an important role in encouraging adherence to ARV treatment regimens by providing education and counselling. However, previous research indicates that interactions are often dominated by the pharmacist. Also, verification of patients’ understanding of information is infrequent and that patients are often passive recipients of instructions. This study aims to identify and describe interactive processes in pharmacy interactions while considering the impact of the disease and macro context on communication. Twenty-six cross-cultural, cross-linguistic pharmacist-patient interactions from a South African HIV/Aids pharmacy are described. Data collection included video recordings, interviews with participants and ethnographic observations in the pharmacy. A hybrid analytical approach incorporated aspects of Conversation Analysis (CA) and Discourse Analysis (DA). The results of this study are particularly encouraging. They demonstrate that despite the presence of cultural, linguistic and other contextual barriers, pharmacist-patient interactions can be efficient. The use of facilitative verbal and non-verbal communication strategies ensures that dosage instructions are successfully communicated by the pharmacist to the patient. In line with prior research, collaboration is promoted when pharmacists create rapport and focus on the lifeworld of the patient. The study shows that intuition and sensitivity to atmosphere in interactions is essential for achieving concordance. The disease context of HIV/Aids has a profound influence on the pharmacistpatient interaction and this study demonstrates the significant impact of the macro ii context on micro aspects of communication. The evidence suggests that the nature of humanity and the daily interface between culture and language in South Africa enables pharmacists and patients to transcend some of the barriers to communication and collaboration that have been identified in previous studies. The findings imply that the diversity of South Africa provides both hope and a resource which can inform policy and future practice.

La non-adhésion (NA) est un enjeu majeur en transplantation rénale (TR). Nous avons réalisé une revue systématique dans laquelle les facteurs liés à la NA sont discutés. Et, sachant que la variabilité des taux sanguins d'anti-calcineurine (CNI) pose la question de NA, nous avons essayé d'identifier les facteurs qui lui sont associés. 37 articles sur l'adhésion ou NA en TR, publiés entre 2009 à 2014, ont été analysés. La NA fluctuait entre 2 et 96% et plusieurs facteurs lui étaient associés : a. jeune, homme, faible support social, sans emploi, faible éducation h. >3 mois post Tx, donneur vivant, >6 comorbidités c. >5 médicaments/j, >2 prises/j d. Croyances et/ou comportements négatifs e. Dépression et/ou anxiété. Puis, nous avons réalisé une étude transversale sur une cohorte de patients à 1 an post greffe de rein. . Les données cliniques, de l'entretien du pharmacien clinicien (PC) et de 6 questionnaires ont été collectées. 408 patients ont été inclus (61.2% d'hommes, âge médian 54 ans). Nous avons comparé 2 groupes selon le coefficient de variation (CV) des CNI : CV<30% (n=302) et >30% (n=106). En analyse univariée la distance hôpital-domicile, la ciclosporine, le délai post greffe et la présence de divergences à la conciliation médicamenteuse, étaient associés à un risque élevé de CV>30%. A l'inverse, le tacrolimus LP conférait un risque plus faible. En analyse multivariée, la présence de divergences était significative (OR=3.2 IC95% [1.21-9.01], p=0.02). Un CV>30% des CNI après 1 an de greffe semble refléter un phénomène de NA pouvant être confirmé par l'entretien avec le PC et constituer un outil simple pour la pratique clinique. / Non-adherence (NA) is a major issue after kidney transplantation (Tx). We realized a systematic review, in which criteria related to NA were discussed. And, considering that calcineurin inhibitors (CNI) blood levels variability raises the question of NA, we tried to identify factors associated to it. 37 studies on adherence and NA in TX, published between 2009 and 2014 were reviewed. NA fluctuated from 2 to 96% and sseveral factors were related to NA: a.Young age, male, low social support, unemployed, low education b. >3 months after Tx, living donor, >6 comorbidities c. >5 drugs/d, > 2 intakes/d d. Negative beliefs and/or behaviors e. Depression and anxiety. Then, we realised a cross sectional study on a cohort of kidney recipients grafted for more than 1 year. We recorded: clinical data, data from a clinical pharmacist (CP) interview and from 6 self-reports. 408 recipients were enrolled (61.2% male, median age 54 years old). We compared 2 groups according to a coefficient of variation (CV) for CNI blood levels: CV<30% (n=302) and >30% (n=106). In univariate analysis, the distance hospital-home, cyclosporine, time since Tx, discrepancies in the reconciliation process were associated with a greater risk of CV>30%. By contrast, tacrolimus once daily conferred a lower risk of CV >30%. In multivariate analysis discrepancies remained significant (OR=3.2 CI 95% [1.21-9.01], p=0.02). ACV >30% for CNI blood levels after lyear post Tx seems to reflect NA, and could easily be confirmed by the CP interview. This could be a simple method to detect NA in clinical routine.