Facilitating interprofessional affective learning in health professional students through digital client documentation: a comparison of simulation modes.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

Non-prescription medicines may contribute to non-adherence to prescription medicines in people living with chronic health conditions.

BACKGROUND: Non-adherence to prescribed medicines is linked to adverse health outcomes in people living with chronic health conditions (CHCs). Multiple factors are known to contribute to non-adherence to medicines including polypharmacy, demographic features and disease and health systems. Both non-prescription and prescription medicines contribute to polypharmacy; however, there is limited data on the influence of non-prescription medicines to non-adherence. AIM: Therefore, the aim of the study was to investigate the influence of non-prescription medicines to non-adherence in an Australian population. METHODS: Data from the 2016 National Survey of a random sample of Australian adult residents were utilised in this study to investigate factors associated with non-adherence. Descriptive statistics, χ2 , regression and generalised linear models were used to assess the relationships between variables of interest. Narrative response and comments were used to provide further insight. RESULTS: This study recruited 1217 participants to explore factors associated with non-adherence to medicines. Weak but statistically significant correlations were identified showing the number of CHCs, patient's age, number of prescription medicines, number of non-prescription medicines and total number of medicines associated with non-adherence. DISCUSSION: The findings suggest that people living with CHCs and taking multiple medicines, including non-prescription medicines, are likely to be non-adherent to prescription medicines. This study shows the possible involvement of non-prescription medicines in contributing to non-adherence in an Australian population and suggests that future studies with a broader demographic are warranted.

Beyond communication training: The MaRIS model for developing medical students' human capabilities and personal resilience.

Purpose: Human capabilities in medicine, including communication skills, are increasingly important within the complex, challenging and dynamic landscape of healthcare. Supporting medical students to manage unavoidable role-related stressors adaptively may help mitigate the anguish that is too commonly reported among the profession. We developed a model, "MaRIS", underpinned by contemplative pedagogy, to support medical students to enhance their human capabilities, across all three domains of Bloom's taxonomy, and their personal resilience. It is the first to integrate Mindfulness, affective Reflection, Impactive experiences and a Supportive environment into medical curriculum design. Here, we describe the theoretical basis underpinning MaRIS and present a preliminary study to evaluate its impact on students' subjectively-rated capabilities.Materials and Methods: A questionnaire capturing self-ratings of competence, empathy and resilience, as well as impressions of their experiences, was administered to foundation year medical students before (T0), during (T1) and after delivery (T2).Results: Fifty-five students completed the survey at all time points. Mean scores for all domains increased significantly from T0 to T1 and from T0 to T2. Free-text comments suggest learning impact across the cognitive, psychomotor and affective domains.Conclusions: MaRIS appears to facilitate medical students' establishment of the foundations for building the human capabilities and personal resilience required for professional practice.

Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV.

Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.

A web-based mental health promotion intervention for pharmacy staff to reduce stigmatising and discriminating attitudes.

ISSUE ADDRESSED: Stigma and discrimination can have a significant impact on successful mental health recovery. This research evaluated the effectiveness of a web-based mental health promotion intervention on stigma and discrimination in community pharmacies via assessment of staff attitudes, confidence and skills. METHODS: Guided by the intervention mapping framework, we used experiential learning techniques, including pre-recorded consumer/carer narratives, role-plays and panel discussions accessed by participants in an innovative, flexible, web-based, program of modules. A quasi-experimental pre-post design was used to evaluate the intervention effectiveness. Participants completed pre- (T1) and post-intervention (T2) questionnaires that contained both validated measures and questions developed or adapted specifically for this evaluation. RESULTS: 566 pharmacy staff (357 pharmacists, 209 support staff) completed the intervention between September 2012 and May 2013; pharmacists completed eight online modules (4-hours total), support staff completed four (2-hours total). After participating, staff attitudes about mental health had changed in a positive direction; their confidence and skills when working with consumers and their carers had increased overall, although support staff remained less confident than pharmacists. CONCLUSION: These results suggest that the involvement of consumers and carers in the intervention development and delivery was integral to reducing pharmacy staff stigma and enhancing confidence and communication skills.

Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review.

In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.

Development of a phenomenologically derived method to assess affective learning in student journals following impactive educational experiences.

BACKGROUND: Assessment of affective learning (AL) is difficult but important, particularly for health professional students, where it is intimately linked to the development of professional values. This study originally aimed to determine whether an emotionally impactive, extended, multimethod, interprofessional simulation experience enhanced the AL of senior medical students, compared to conventional seminars and workshops alone. This necessitated the development of a method to assess for the presence and quality of AL. METHODS: We developed a "double hermeneutic" method, derived from Smith's Interpretative Phenomenological Analysis, to identify examples of AL, according to Krathwohl's hierarchy ("receiving," "responding," "valuing," "organization," "characterization"), in the journals of students from each arm of a randomized educational trial. Three assessors rated the highest level of AL seen in each journal and then we compared ratings from the two study arms. RESULTS: A total of 135 journals were available for assessment (81 Intervention, 54 Control). The method proved to be effective in identifying and characterizing examples of uniprofessional and interprofessional AL. The median level identified in Intervention journals ("valuing") was significantly higher than Control journals ("responding," p < 0.0001). CONCLUSIONS: The method described provides a means to assess affective learning among health professional students. An extended, immersive simulation experience appears to enhance affective learning.

Australian mental health consumers' and carers' experiences of community pharmacy service.

BACKGROUND: Many Australians with anxiety or depression experience issues accessing pharmacological treatment even though community pharmacies are remunerated to supply subsidized medicines and provide medicine management services. OBJECTIVE: To obtain insight into the quality of community pharmacy services from the perspectives of mental health consumers and carers. METHODS: A computer-assisted telephone interview was used to gauge perceptions of pharmacy service using frameworks of service quality and patient-centred care. A convenience sample of 210 consumers and carers from three Australian states completed an interview comprising rating scales, multiple choice checklists and open-ended questions to explore their experience of pharmacy services. RESULTS: Participants were consumers experiencing on-going mental health condition(s) (n = 172), carers for someone who experienced a mental health condition (n = 15) or both (n = 23). For 60% of participants, medicines were dispensed within ten minutes of arriving at the pharmacy, and 36% received verbal advice. The majority of participants were not asked by pharmacy staff whether they experienced side-effects, and 60% reported rarely or never receiving written medicine information. However, the majority of participants reported that their expectations were met despite the absence of such services. Qualitative data showed that participants valued high-quality services that reflected patient-centred care, and they were inclined to engage with these services particularly if they perceived them as surpassing basic expectations. DISCUSSION AND CONCLUSIONS: Participants clearly valued high-quality pharmacy service yet did not routinely expect it. When service exceeded expectations, community pharmacies were viewed as safe health-care spaces to seek advice on mental health and well-being. This study has positive implications for the role of pharmacists.

Review of community pharmacy staff educational needs for supporting mental health consumers and carers.

Development of a mental health education package for community pharmacy staff should be informed by mental health consumers/carers' needs, expectations and experiences, and staff knowledge, skills and attitudes. This review (1) explored research on community pharmacy practice and service provision for mental health consumers/carers, and (2) identified validated methods for assessing staff knowledge, skills and attitudes about mental illness to inform the development of a training questionnaire. A literature scan using key words knowledge, skills, attitudes, and beliefs combined with community pharmacy, pharmacist, and pharmacy support staff, and mental illness, depression, anxiety was conducted. A small number of studies were found that used reliable methods to assess pharmacists' training needs regarding mental illness and treatment options. There was little published specifically in relation to depression and anxiety in community pharmacy practice. No studies assessed the training needs of pharmacy support staff. A systematic analysis of pharmacy staff learning needs is warranted.