Determinants of Health-Related Quality of Life in Outpatients with Myocardial Infarction.

Background: The health-related quality of life (HRQOL) of patients with myocardial infarction (MI) is suboptimal because of the disease's life-threatening nature, the requirement for long-term lifestyle modifications, and the treatment regimens following MI. This study aimed to evaluate HRQOL and its associated factors in MI patients. Material and Methods: This study was conducted on patients with MI who attended the outpatient cardiology clinic at a major teaching hospital in Jordan. The EQ-5D-3L questionnaire was used to assess HRQOL of the study participants. Quantile regression analysis was conducted to identify the variables associated with HRQOL. Results: The study included 333 patients with a history of MI, with a median age of 58 (57-60). The median of the total EQ-5D score was 0.65 (0.216-0.805). Regression results revealed that male patients (Coefficient= 0.110, 95%Cl (0.022-0.197), P=0.014) and not being diagnosed with diabetes (Coefficient= 0.154, 95%Cl (0.042-0.266), P=0.007) were associated with increased HRQOL. On the other hand, low income (Coefficient= -0.115, 95%Cl (-0.203 - -0.026), P=0.011), not receiving DPP-4 (Dipeptidyl Peptidase -4) inhibitors (Coefficient= -0.321 95%Cl (-0.462 - -0.180), P<0.001), and having low (Coefficient= -0.271, 95%Cl (-0.395 - -0.147), P<0.001) or moderate (Coefficient= -0.123, 95%Cl (-0.202 - -0.044), P=0.002) medication adherence was associated with decreased HRQOL. Conclusion: The current study demonstrated diminished HRQOL among patients with MI, highlighting the necessity of tailoring interventions to tackle medication adherence barriers in this population. Personalized interventions such as educational programs, counseling, and reminders that consider each patient's needs and circumstances can greatly enhance medication adherence and, thus, the HRQOL of MI patients. Individuals with lower income levels, female patients, and those with diabetes should be the specific targets of these interventions.

Role of Community Pharmacist in Asthma Management: Knowledge, Attitudes and Practice.

Purpose: To investigate knowledge, attitude, and practice of asthma management counseling and the perceived barriers by community pharmacists. Methods: This cross-sectional study was conducted on 416 community pharmacists using an online-based questionnaire. The questionnaire included five parts that assessed socio-demographics and medical references used to seek drug-related information, pharmacists' knowledge (7 items), attitudes (5 items), practice (22 items) and the barriers for the provision of asthma management counseling (10 items). Binary logistic regression was conducted to find the variables that were significantly and independently associated with knowledge, attitude and asthma management counseling practice. Results: Increased years of experience was associated with decreased knowledge (OR = 0.918, 95% Cl (0.869:0.970), P = 0.002) and less positive attitude toward asthma management (OR = 0.876, 95% Cl. (0.821:0.935), P < 0.001), while working in independent community pharmacy (OR = 2.097, 95% Cl. (1.273:3.454), P = 0.004) and increased awareness of asthma management guidelines (OR = 1.60, 95% CI. (1.044:2.453), P = 0.031) increased the odds of being in the high knowledge group. In contrast, increasing the daily number of pharmacy visitors OR = 1.009, 95% Cl. (1.001:1.016), P = 0.024) and having a pharmacy degree (OR = 2.330, 95% Cl. (1.256:4.326), P = 0.007) increased the odds of having a positive attitude. Male pharmacists (OR = 0.553, 95% Cl. (0.350:0.873), P = 0.011) and having bachelor in pharmacy (OR = 0.354, 95% Cl. (0.179:0.700), P = 0.003) decreased the odds of being in the high practice group. On the other hand, increased awareness of asthma management guidelines tripled the odds of being in the high practice group (OR = 3.067, 95% Cl. (1.964:4.787), P < 0.001). Conclusion: The current study findings offer valuable insights into the gaps in knowledge, attitude, and practice of asthma management counseling among community pharmacists, as well as the barriers and factors that impede the provision of these services. These insights serve as a guide for developing future strategies aimed at enhancing the role of pharmacists in asthma care.

Public perception, satisfaction and expectations from community pharmacy services and the barriers to consult the community pharmacist.

This cross-sectional study aimed to evaluate public perception, satisfaction, expectations, and barriers to utilize the community pharmacy services. A validated self-reported online survey was distributed on 681 individuals in different regions across Jordan. The mean age of the participants was 29 (±10) years. The most reported reason for choosing a particular community pharmacy was its closure to home or workplace (79.1%), while the main reason for visiting a community pharmacy was to obtain over the counter medications (66.2%). The participants showed good perception, satisfaction, and expectations of community pharmacy services. However, several barriers were identified, including higher participants' trust in physicians when compared to pharmacists (63.1%), and lack of privacy in the pharmacy (45.7%). Community pharmacists should participate in successful education and training programs in order to raise the quality of the provided services, meet patient requirements, and re-establish consumer confidence in community pharmacists.

Public knowledge and attitude towards drug-food interactions: implications for improved public health safety.

Drug-Food Interaction (DFI) can potentially lead to treatment ineffectiveness and adverse health outcomes. This study investigated knowledge and attitude towards DFI and the associated factors. A validated questionnaire was distributed to 2040 participants across Jordan. The participants had moderate knowledge and attitudes regarding DFIs. Regression results revealed that male gender, lower education level, not working in the healthcare sector, and utilizing non-scientific sources of information about DFIs were associated with lower knowledge about DFI. Furthermore, male gender, being unmarried, having a low or moderate education level, not working in the healthcare sector, not having a family member with chronic disease, and having low knowledge of DFI were significantly associated with negative attitudes towards DFIs. Future health education programs should emphasize using reliable scientific sources to enhance awareness about DFIs'. Additionally, healthcare professionals should counsel patients on avoiding DFIs and provide guidance accordingly.

Health-related quality of life and its associated factors in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The present study aimed to evaluate HRQOL and to explore the factors associated with poor HRQOL among patients with COPD. METHODS: In the present cross-sectional study, the validated St George's Respiratory Questionnaire for COPD patients (SGRQ-C) was used to evaluate HRQOL among 702 patients with COPD at two major hospitals in Jordan in the period between January and April 2022. Quantile regression analysis was used to explore the factors associated with HRQOL among the study participants. RESULTS: According to SGRQ-C, the HRQOL of the study participants was greatly impaired with a total SGRQ of 55.2 (34-67.8). The highest impairment in the HRQOL was in the impact domain with a median of 58.7 (29-76.3). Increased number of prescribed medications (ß = 1.157, P<0.01), older age (ß = 0.487, P<0.001), male gender (ß = 5.364, P<0.01), low education level (ß = 9.313, P<0.001), low and moderate average income (ß = 6.440, P<0.05, and ß = 6.997, P<0.01, respectively) were associated with poorer HRQOL. On the other hand, being married (ß = -17.122, P<0.001), living in rural area (ß = -6.994, P<0.01), non-use of steroids inhalers (ß = -3.859, P<0.05), not receiving long acting muscarinic antagonists (LAMA) (ß = -9.269, P<0.001), not receiving LABA (ß = -8.243, P<0.001) and being adherent to the prescribed medications (ß = -6.016, P<0.001) were associated with improved HRQOL. Furthermore, lower disease severity (stage A, B, and C) (ß = -23.252, -10.389, and -9.696 respectively, P<0.001), and the absence of comorbidities (ß = -14.303, P<0.001) were associated with better HRQOL. CONCLUSIONS: In order to maximize HRQOL in patients with COPD, future COPD management interventions should adopt a multidisciplinary approach involving different healthcare providers, which aims to provide patient-centered care, implement personalized interventions, and improve medication adherence, particularly for patients who are elderly, males, have low socioeconomic status, receive multiple medications and have multiple comorbid diseases.

Colorectal cancer screening among the public: knowledge, attitudes, and the perceived barriers.

Colorectal cancer (CRC)1 screening tests help in early detection of CRC and improve disease prognosis. This study aimed to assess knowledge, attitude, and barriers to CRC screening and the associated factors among the general population in Jordan. A validated self-administered online survey was distributed on 1542 individuals in Jordan. The participants (n = 1542) reported several barriers and demonstrated insufficient knowledge but positive attitude towards CRC screening. Older age (OR = 1.021, 95% CI = 1.010-1.032, P < 0.001), working in medical field (OR = 3.198, 95% CI = 2.499-4.092, P < 0.001), family history of cancer (OR = 1.248, 95% CI = 1.002-1.555, P < 0.05), and knowing someone with CRC (OR = 1.601, 95% CI = 1.186-2.161, P < 0.01) were significantly associated with higher knowledge. Personal history of CRC (OR = 3.157, 95% CI = 1.188-8.387, P < 0.05), and high knowledge of CRC (OR = 2.795, 95% CI = 2.242-3.484, P < 0.001) were significantly associated with the positive attitude. Future healthcare programs should devise effective techniques to improve public understanding and perception of CRC screening and overcome the identified barriers.

Patterns of drug-related problems and the services provided to optimize drug therapy in the community pharmacy setting.

Introduction: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes. Objectives: To assess community pharmacists' knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services. Methods: This cross-sectional study utilized a validated questionnaire to assess pharmacists' knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services. Results: A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients' inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010-5.590, P < 0.001), while increased weekly working hours (OR: 0.966, 95%Cl: 0.947-0.986), P < 0.01) and serving < 10 patients daily (OR = 0.208, 95%Cl: 0.072-0.601, P < 0.01) decreased it. Conclusions: Community pharmacists' practice of DRP-reduction services showed a scope for improvement. Future pharmaceutical care initiatives should increase the number of personnel working in the pharmacy and provide them with opportunities for continued education and training in order to improve the provision of DRP services and optimize patients' outcomes.

Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial: a protocol for a multicentre, stepped-wedge cluster randomized trial.

BACKGROUND: Evidence-based Practice for Improving Quality (EPIQ) is a collaborative quality improvement method adopted by the Canadian Neonatal Network that led to decreased mortality and morbidity in very preterm neonates. The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial aims to evaluate the impact of EPIQ collaborative quality improvement strategies in moderate and late preterm neonates in Alberta, Canada. METHODS: In a 4-year, multicentre, stepped-wedge cluster randomized trial involving 12 neonatal intensive care units (NICUs), we will collect baseline data with the current practices in the first year (all NICUs in the control arm). Four NICUs will transition to the intervention arm at the end of each year, with 1 year of follow-up after the last group transitions to the intervention arm. Neonates born at 32 + 0 to 36 + 6 weeks' gestation with primary admission to NICUs or postpartum units will be included. The intervention includes implementation of respiratory and nutritional care bundles using EPIQ strategies, including quality improvement team building, quality improvement education, bundle implementation, quality improvement mentoring and collaborative networking. The primary outcome is length of hospital stay; secondary outcomes include health care costs and short-term clinical outcomes. Neonatal intensive care unit staff will complete a survey in the first year to assess quality improvement culture in each unit, and a sample will be interviewed 1 year after implementation in each unit to evaluate the implementation process. INTERPRETATION: The ABC-QI Trial will assess whether collaborative quality improvement strategies affect length of stay in moderate and late preterm neonates. It will provide detailed population-based data to support future research, benchmarking and quality improvement. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT05231200.

Translating and piloting a cardiovascular risk assessment and management online tool using mobile technology.

Background: Cardiovascular disease (CVD) risk assessment and management (RAM) services face many challenges and barriers in the community. Mobile technology offers the opportunity to empower patients and improve access to health prevention strategies to overcome these barriers. However, there is limited information on the availability and use of CVDRAM-related mobile technology in the Arabic language. Objectives: To pilot test an Arabic version of a CVDRAM application among potential end-users accessing community pharmacy services in Qatar. Methodology: Translation of an established cardiovascular risk calculator (EPI·RxISK™) into the Arabic language was conducted. The English/Arabic version of the calculator was tested by potential end-users, consisting of a sample of community pharmacists (CRxs) and members of the public (MOP) accessing community pharmacy services. Semi-structured interviews were conducted based on the quality attributes of the Mobile Application Rating Scale (MARS). Data were analyzed using deductive content analysis. Results: A total of 10 CRxs and 5 MOP were interviewed. Five themes emerged to describe the EPI·RxISK™ calculator: Engagement, Functionality, Attractiveness, Education, and Responsiveness. For the most part, positive subthemes were associated with each of these themes. The functionality and educational themes had some negative subthemes. Conclusion: End-users of the EPI·RxISK™ calculator had mostly positive descriptors that were aligned with all five quality attributes of the web and mobile applications.

Impact of the Novel CoronaviruS (COVID-19) on Frontline PharmacIsts Roles and ServicEs: INSPIRE Worldwide Survey.

BACKGROUND: Pharmacy has been recognized as a vital healthcare profession during the COVID-19 pandemic. The primary objective of the INSPIRE Worldwide survey was to determine the impact of COVID-19 on pharmacy practice and pharmacists' roles around the world. METHODS: A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Participants were recruited through social media, with assistance from national and international pharmacy organizations between March 2021-May 2022. The questionnaire was divided into (1) demographics, (2) pharmacists' roles, (3) communication strategies, and (4) practice challenges. The data were analyzed using SPSS 28, and descriptive statistics were used to report frequencies and percentages. RESULTS: A total of 505 pharmacists practicing in 25 countries participated. The most common role that pharmacists undertook was responding to drug information requests (90%), followed by allaying patients' fears and anxieties about COVID-19 (82.6%), and addressing misinformation about COVID-19 treatments and vaccinations (80.4%). The most common challenges were increased stress levels (84.7%), followed by medication shortages (73.8%), general supply shortages (71.8%), and inadequate staffing (69.2%). CONCLUSIONS: Pharmacists within this study were significantly impacted by the COVID-19 pandemic and took on new or adapted roles (e.g., providing COVID-specific information, managing patients' emotions, and educating on public health measures) to meet the needs of their communities. Despite, the significant challenges (e.g., increased stress, supply chain challenges, addressing misinformation, and staffing shortages) faced by pharmacists, they continued to put their patients' needs first and to provide pharmacy services.

A photovoice study on community pharmacists' roles and lived experiences during the COVID-19 pandemic.

BACKGROUND: Community pharmacists were the face of the health response to the unprecedented COVID-19 pandemic. Their pivotal role during the pandemic has been widely recognized, as they adapted to continue to provide a higher level of care to their patients. OBJECTIVE: The objective of this study was to gain a deeper understanding of frontline pharmacists' lived experiences of the COVID-19 pandemic and its impact on their roles. METHODS: Photovoice, a visual research method that uses participant-generated photographs to articulate their experiences, was used with semi-structured interviews to explore pharmacists' lived experiences. Frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada were recruited. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. A published conceptual framework model was used as the foundation of the analysis with care taken to include new concepts. Ethics approval was obtained from the University of Alberta health research ethics board. RESULTS: Interviews were conducted with 21 participants and they 71 photos. This study advanced the conceptual framework model presented in a scoping review, of what was made visible (pharmacists' information, public health, and medication management roles) and what was invisible but made visible by the pandemic (pharmacists' leadership roles). It was revealed through the reflective nature of this study the important leadership role pharmacists have in their communities. CONCLUSIONS: This study highlighted the work of community pharmacists responding to the COVID-19 pandemic through their information, public health, medication management, and leadership roles. Their experiences also made visible the cost their work had on them as they did more to adapt and continually respond as the pandemic evolved. Pharmacists recognized their role as leaders in their practice and communities.

A prospective observational study of the efficacy of ketamine for rescue analgesia in the postanesthesia recovery unit.

BACKGROUND: Early severe postoperative pain is frequently resistant to management with opioid analgesia alone. Perioperative low-dose ketamine as an analgesia adjunct has been studied extensively. Its efficacy as a rescue analgesic in the postanesthesia care unit (PACU) has not been determined. The objective of this study was to evaluate the analgesic efficacy of low-dose bolus ketamine for opioid-resistant pain in the PACU by measuring its effect on numerical rating scale (NRS) pain scores and opioid requirement. METHODS: This was a prospective observational study of adult noncardiac surgery patients with significant postoperative pain in the PACU. Patients were administered bolus doses of intravenous ketamine in 10-mg increments, repeated two to three times to an approximate maximum dose of 0.25 mg·kg-1. Primary outcomes were resting pain score reduction and opioid use from time of bolus ketamine administration to 30 min after administration of final ketamine bolus. The secondary outcome was incidence of side effects from ketamine administration. RESULTS: A convenience sample of 100 patients was chosen. The mean (standard deviation) NRS resting pain score reduction 30 min after iv ketamine administration was 2.7 (1.8) (P < 0.001). Patients with a history of previous opioid use or chronic pain were not more responsive to the effects of low-dose bolus ketamine. There were no ketamine-related adverse effects in any of the study patients. CONCLUSION: Administration of low-dose bolus ketamine in the PACU for severe opioid-resistant pain was associated with a significant improvement in analgesia in this observational study.

RéSUMé: CONTEXTE: La douleur postopératoire sévère précoce est souvent résistante à une prise en charge par analgésie opioïde seule. La kétamine périopératoire à faible dose en tant qu'analgésie adjuvante a fait l'objet d'études approfondies. Son efficacité en tant qu'analgésie de secours en salle de réveil est encore mal déterminée. L'objectif de cette étude était d'évaluer l'efficacité analgésique d'un bolus de kétamine à faible dose pour soulager la douleur résistante aux opioïdes en salle de réveil en mesurant son effet sur les scores de douleur sur une échelle d'évaluation numérique (EEN) et sur les besoins en opioïdes. MéTHODE: Il s'agissait d'une étude observationnelle prospective auprès de patients adultes ayant bénéficié d'une chirurgie non cardiaque et présentant une douleur postopératoire importante en salle de réveil. Les patients ont reçu des bolus de kétamine intraveineuse par tranches de 10 mg, répétés deux à trois fois jusqu'à une dose maximale approximative de 0,25 mg·kg−1. Les critères d'évaluation principaux étaient la réduction du score de douleur au repos et la consommation d'opioïdes à partir du moment de l'administration de kétamine en bolus jusqu'à 30 minutes après l'administration du bolus final de kétamine. Le critère d'évaluation secondaire était l'incidence d'effets secondaires liés à l'administration de kétamine. RéSULTATS: Un échantillon de commodité de 100 patients a été choisi. La réduction moyenne (écart type) du score de douleur au repos sur l'EEN 30 min après l'administration de kétamine iv était de 2,7 (1,8) (P < 0,001). Les patients ayant des antécédents de consommation antérieure d'opioïdes ou de douleur chronique n'étaient pas plus sensibles aux effets de la kétamine en bolus à faible dose. Il n'y a eu aucun effet indésirable lié à la kétamine chez aucun des patients de l'étude. CONCLUSION: L'administration de kétamine en bolus à faible dose en salle de réveil pour soulager la douleur sévère résistante aux opioïdes a été associée à une amélioration significative de l'analgésie dans cette étude observationnelle.

Evaluating the impact of patient-reported outcome measures on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial.

BACKGROUND: Multiple sclerosis (MS) is a chronic disease affecting multiple functional aspects of patients' lives. Depression and anxiety are common amongst persons with MS (PwMS). There has been an interest in utilizing patient-reported outcome measures (PROMs) to capture and systematically assess patient's perceptions of their MS experience in addition to other clinical measures, but PROMs are not usually collected in routine clinical practice. Therefore, this study aims to systematically incorporate periodic electronically administered PROMs into the care of PwMS to evaluate its effects on depression and anxiety. METHODS: A randomized controlled trial will be conducted with patients allocated 1:1 to either intervention or conservative treatment groups. Patients in the intervention group will complete PROMs at the start of the study and then every 6 months for 1 year, in addition to having their MS healthcare provider prompted to view their scores. The conservative treatment group will complete PROMs at the start of the study and again after 12 months, and their neurologist will not be able to view their scores. For both groups, pre-determined critical PROM scores will trigger an alert to the patient's MS provider. The difference in change in Hospital Anxiety and Depression Scale score between the intervention and conservative treatment groups at 12 months will be the primary outcome, along with difference in Consultation Satisfaction Questionnaire and CollaboRATE scores at 12 months, and proportion and type of healthcare provider intervention/alerts initiated by different PROMs as secondary outcomes. DISCUSSION: This study will determine the feasibility of utilizing PROMs on an interval basis and its effects on the psychological well-being of PwMS. Findings of this study will provide evidence on use of PROMs in future MS clinical practice. TRIAL REGISTRATION: This trial is registered at the National Institutes of Health United States National Library of Medicine, ClinicalTrials.gov NCT04979546 . Registered on July 28, 2021.

The effect of nurse practitioner (NP-led) care on health-related quality of life in people with multiple sclerosis - a randomized trial.

BACKGROUND: Care for People with Multiple Sclerosis (PwMS) is increasingly complex, requiring innovations in care. Canada has high rates of MS; it is challenging for general neurologists to optimally care for PwMS with busy office practices. The aim of this study was to evaluate the effects of add-on Nurse Practitioner (NP)-led care for PwMS on depression and anxiety (Hospital Anxiety and Depression Scale, HADS), compared to usual care (community neurologist, family physician). METHODS: PwMS followed by community neurologists were randomized to add-on NP-led or Usual care for 6 months. Primary outcome was the change in HADS at 3 months. Secondary outcomes were HADS (6 months), EQ5D, MSIF, CAREQOL-MS, at 3 and 6 months, and Consultant Satisfaction Survey (6 months). RESULTS: We recruited 248 participants; 228 completed the trial (NP-led care arm n = 120, Usual care arm n = 108). There were no significant baseline differences between groups. Study subjects were highly educated (71.05%), working full-time (41.23%), living independently (68.86%), with mean age of 47.32 (11.09), mean EDSS 2.53 (SD 2.06), mean duration since MS diagnosis 12.18 years (SD 8.82) and 85% had relapsing remitting MS. Mean change in HADS depression (3 months) was: -0.41 (SD 2.81) NP-led care group vs 1.11 (2.98) Usual care group p = 0.001, sustained at 6 months; for anxiety, - 0.32 (2.73) NP-led care group vs 0.42 (2.82) Usual care group, p = 0.059. Other secondary outcomes were not significantly different. There was no difference in satisfaction of care in the NP-led care arm (63.83 (5.63)) vs Usual care (62.82 (5.45)), p = 0.194). CONCLUSION: Add-on NP-led care improved depression compared to usual neurologist care and 3 and 6 months in PwMS, and there was no difference in satisfaction with care. Further research is needed to explore how NPs could enrich care provided for PwMS in healthcare settings. TRIAL REGISTRATION: Retrospectively registered on clinicaltrials.gov ( ClinicalTrials.gov Identifier: NCT04388592 , 14/05/2020).

Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study.

INTRODUCTION: Patient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial. METHODS AND ANALYSIS: Using a mixed-methods study design, we will evaluate patient partners' engagement activities across set time-points during the trial and after trial completion. In this study, the term 'patient partner' is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15-24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Approval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly. TRIAL REGISTRATION NUMBER: NCT04902391.

Retroactive application of the EPIS framework to promote future implementation success in community pharmacy clinical interventions.

BACKGROUND: The assessment of the implementation process of a clinical intervention in a community pharmacy setting can reveal useful insights for future implementation efforts. OBJECTIVE: We aimed to examine the implementation of a community pharmacist-led prospective registry and practice tool (RxING, Epidemiology Research Coordinating Center and the University of Alberta) designed to reduce cardiovascular risk among patients with diabetes and to assess how the participating pharmacists could be supported at each of these stages. METHODS: Semistructured interviews were conducted developed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The EPIS framework was used to evaluate the implementation of an online, guideline-driven tool (RxING tool) designed to help pharmacists implement and document the care of patients with diabetes by a group of community pharmacies located in Alberta, Canada. RESULTS: In relation to the preparation phase, responses focused more on suitability of the work environments and less on workflow adjustment. With regard to the implementation stage, participants mentioned that often the pharmacy manager or owner received the training to operate the RxING tool, complicating their ability to engage in regular patient recruitment and follow-up. Most pharmacies did not have specific goals relating to patient recruitment and retention. Concerns hindering sustainability of the evidence-based practice centered around the time-consuming online documentation process and patient retention. Finally, innovation factors identified from the pharmacists' responses were related to patient recruitment and streamlining the documentation process. CONCLUSIONS: This study identified 17 key recommendations that should be considered when designing and implementing future community pharmacy-led projects. In particular, providing assistance and training to pharmacies on-site, specific planning for program roll-out, identifying participating staff who have the time to engage with the program, and troubleshooting how to best integrate programs in normal workflow processes are some key recommendations.

Quantifying the cost of single-use minims and multidose bottles for eye drops in routine ophthalmic practice: a multicentre study.

OBJECTIVE: To compare costs between two different eye drop delivery modalities: multidose bottles and single-use minims. DESIGN: Retrospective cohort study. METHODS: Monthly dilating eye drop costs and quantities (tropicamide 1%, phenylephrine 2.5%, cyclopentolate 1%) were studied over a 2-year period between April 2013 and March 2015 at 2 tertiary ophthalmic centres (Royal Alexandra Hospital [RAH, Edmonton] and Rockyview General Hospital [RGH, Calgary]). In April 2014, RAH switched its dilating eye drop practice from predominantly multidose bottles to single-use minims, whereas RGH continued using predominantly multidose bottles. Eye drop volume and total and per-patient eye drop costs were quantified at RAH before switching (pre-intervention) and after (post-intervention) using an interrupted time-series analysis with RGH as a control. A counterfactual analysis was also performed. Significance was obtained using independent t-testing. RESULTS: After switching to single-use minims, RAH experienced changes in the following: an increase in single-use minims as a proportion of total eye drop utilization (from 5.6% to 89.1%; p = 0.001), an increase in total eye drop cost by $2117 per month (95% confidence interval [CI], $1354-$2880; p < 0.001), an increase in per-patient costs by $984 per 1000 patients per month (95% CI, $674-$1293). Contrastingly, RGH did not experience similar changes. Ultimately, the cost of switching to single-use minims was $22 481 (95% CI, $7830-$31 336) over a 12-month period. CONCLUSIONS: If safe eye drop practices are enforced via proper protocols, the use of multidose bottles may be a more cost-effective option than single-use minims for routine clinical practice.

Impact of a "Pharmacist First" innovative workflow plan in patients with hypertension and/or diabetes.

Usual community pharmacy workflow, whereby patients might see a pharmacist at the end of the dispensing process, is not conducive to proactive patient-centred care. The objective of this study was to evaluate the impact of the "Pharmacist First" (P1st) workflow model on blood pressure and glycemic control in patients with hypertension and/or diabetes. This retrospective review was set in 2 community pharmacies that use the P1st model in the Greater Edmonton Region. The population entailed patients with hypertension and/or type 1 or 2 diabetes who received care via the P1st workflow model. The P1st workflow model places the patient in immediate contact with the pharmacist. The pharmacist first assesses prescription appropriateness, reviews relevant laboratory tests, discusses chronic disease control and addresses any questions or concerns the patient has before passing the prescription to be filled by a technician. This allows issues or concerns to be identified and addressed up front, rather than waiting until the prescription is filled and the patient is ready to leave the pharmacy. The primary outcome assessed in this study was change in blood pressure and/or A1C from baseline to the last follow-up visit. We reviewed 215 patient records. The mean age was 69.4 years (standard deviation 12.5), 51.2% of patients were male, 57.7% had hypertension, 5.6% had diabetes, and 36.7% had both. Median follow-up time was 4.2 months (interquartile range 2.5-9.3). In 203 patients with hypertension, systolic blood pressure was reduced from 139.83 mmHg to 131.26 mmHg (p < 0.001) and diastolic blood pressure from 80.26 mmHg to 76.86 mmHg (p < 0.001). In 87 patients with diabetes, A1C changed from 7.4% to 7.2% (p = ns). The P1st workflow model demonstrated significant improvements in blood pressure. Further investigation is needed to evaluate the effectiveness of this model with a control group, longer follow-up and evaluation of the patient experience.